Independent Predictor Of Complications Research Articles

Body mass predicts the survival of patients with new International Federation of Gynecology and Obstetrics Stage IB1 and IB2 cervical carcinoma treated with radical hysterectomy.

The authors evaluated the impact of body mass on survival and morbidity of patients with new International Federation of Gynecology and Obstetrics (FIGO) Stage IB1 and IB2 cervical carcinoma managed with radical hysterectomy. Two hundred twenty-nine patients with Stage IB1 or IB2 cervical carcinoma treated with radical hysterectomy were studied in a multivariate logistic regression analysis. The body mass index (BMI) and the ponderal index (PI) were used as measures of body mass and were analyzed as predictors of recurrence, survival, and complications in light of the new staging system. Twenty-seven of 229 patients died of recurrent disease. A low BMI or a high PI were predictive of poor survival. Tumor greatest dimension, lymph node involvement, BMI, and PI were all independent predictors of survival (P=0.0006). The only independent predictor of complications was para-aortic lymph node dissection (P=0.0026). Cervical carcinoma patients with a low body mass, as indicated by a low BMI or a high PI, were found to have poor survival after undergoing radical hysterectomy. Additional predictors of poor survival included lymph node metastases and increased tumor size. BMI and PI are more important predictors of survival than the new FIGO Stages IB1 and IB2. Body mass is not predictive of complications.

Toward improving outcomes of ERCP

Toward improving outcomes of ERCP

Radical Hysterectomy for Stage IB1 vs IB2 Carcinoma of the Cervix: Does the New Staging System Predict Morbidity and Survival?

Two hundred twenty-nine patients with Stage IB cervical cancer treated with radical hysterectomy were assigned to the new FIGO substages IB1 (n= 181) and IB2 (n= 48) based on clinical tumor diameter. Our purpose was to determine the impact of the new staging system for IB1 and IB2 cervical cancer on nodal status and survival. Additionally, we analyzed the morbidity of radical hysterectomy in light of the new staging system. The complications were similar between the two groups. Para-aortic lymphadenectomy was the only independent predictor of complications (P= 0.00026). Stage IB2 patients did have a significantly worse 5-year survival (72.8%) when compared with IB1 (90.0%) (P= 0.0265). Multivariate stepwise logistical regression analysis indicated that the new staging system did not have an independent impact on survival. Stage acts through nodal status in its impact on survival. Positive lymph nodes, tumor diameter, and Ponderal Index are all independent predictors of survival (P= 0.0001). Patients with Stage IB2 carcinoma of the cervix undergoing radical hysterectomy showed no significant increase in morbidity when compared with patients with Stage IB1 disease treated with the same procedure.

Complications of diagnostic electrophysiologic studies and radiofrequency catheter ablation in patients with tachyarrhythmias: An eight-year survey of 3,966 consecutive procedures in a tertiary referral center

Predictors and comparisons of complications in patients with electrophysiologic study or radiofrequency ablation have not been assessed in previous published reports. The purpose of this study was to prospectively evaluate the procedure-specific complications and investigate the possible causes and predictors of complications in electrophysiologic study and radiofrequency ablation. Data or diagnostic electrophysiologic studies and radiofrequency ablation were prospective, and represented a consecutive series of 2,593 patients with 3,966 procedures. The present study showed that a significantly higher complication rate occurred in radiofrequency ablation than in electrophysiologic study (3.1% vs 1.1%, respectively, p = 0.00002) and a significantly higher complication rate occurred in elderly than in young patients with electrophysiologic study (2.2% vs 0.5%, p = 0.0002) or radiofrequency ablation (6.1% vs 2.0%, p = 0.00015). Multiple logistic analysis found that older age (p < 0.01) and systemic disease in elderly patients (p < 0.01) were the independent predictors of complications in both procedures. Furthermore, there was no temporal trend in the incidence of complication. We conclude that the incidence of complication was higher in radiofrequency ablation, and elderly patients had a higher incidence of complications in both electrophysiologic study and radiofrequency ablation; these procedures, when performed by experienced personnel in an appropriately staffed and equipped laboratory, can be undertaken with an acceptable risk.

Assessment of Operative Risk in Patients Undergoing Lung Resection

Objective To evaluate the ability of preoperative variables to identify patients at increased risk for complications after lung resection and the usefulness of predicted postoperative FEV1 as a marker of risk for adverse outcomes. Design Prospective analysis of a cohort of patients undergoing pulmonary resection. Complication rates were analyzed according to preoperative pulmonary variables, demographic variables, procedure performed, and predicted postoperative FEV1. Predicted postoperative FEV1 was calculated using a formula estimating the decline in preoperative FEV1 based on the number of bronchopulmonary segments removed during surgery. Setting A major teaching hospital and tertiary referral center. Patients A consecutive series of patients undergoing pulmonary resection. Measurements and main results Medical complications were recorded as part of an ongoing clinical database. The overall complication rate was low (17 percent rate of any complication, 1 percent death rate). Univariate predictors of complications included age ≥ 60, male sex, history of smoking, a pneumonectomy procedure, and a low predicted postoperative FEV1. Hypercarbia (≥45 mm Hg) on preoperative arterial glood gas analysis, desaturation on exercise oximetry (≤ 90 percent), and a preoperative FEV1 less than 1 L were not predictive of complications. When the effect of these variables was controlled for in a multivariate analysis, a low predicted postoperative FEV1 remained the only significant independent predictor of complications. For each 0.2 L decrease in predicted FEV1, the odds ratio for complications was 1.46 (95 percent confidence interval [CI] 1.2 to 1.8). Conclusions: A low predicted postoperative FEV1 appears to be the best indicator of patients at high risk for complications, and it was the only significant correlate of complications when the effect of other potential risk factors was controlled for in a multivariate analysis. Pulmonary resection should not be denied on the basis of traditionally cited preoperative pulmonary variables, and a prediction of postoperative pulmonary function by a technique of simple calculation may be useful to identify patients at increased risk for medical complications.

Angina and persistent exercise thallium defects: Independent risk factors in elective vascular surgery

Objectives. In this study, we assessed the utility of exercise thallium-201 scintigraphy and other clinical factors in predicting perioperative cardiac complications in patients undergoing elective vascular surgery.Background. The risk of cardiac complications among such patients is very high.Methods. The study group comprised 116 men (mean age 67 years). Fifty patients (43%) had a history of coronary artery disease, including angina pectoris in 26 (22%), myocardial infarction in 32 (28%) and coronary artery bypass surgery in 19 (16%).Results. There were a total of 22 perioperative myocardial infarctions (18.9%), including 2 cardiac deaths (1.7%). A significantly greater proportion (p < 0.05) of patients with than without perioperative complications had a history of coronary artery disease (77% vs. 35%), angina (59% vs. 14%), prior myocardial infarction (50% vs. 22%), abnormal electrocardiogram (68% vs. 40%) and abnormal exercise thallium test (75% vs. 47%). The patient group with complications also had a significantly lower mean rest ejection fraction (45 ± 3% vs. 55 ± 2%, p < 0.005). Independent predictors of complication, as determined by straight logistic regression, were angina aad fixed thallium defects after exercise.Conclusions. Our data indicate that angina and the presence of fixed thallium defects after exercise are independent predictors of cardiac risk in patients undergoing elective vascular surgery. These findings are compatible with other studies showing that nonredistribution on standard 3- to 4-h delayed studies cannot exclude viable myocardium at risk.

The Preoperative and Intraoperative Hemodynamic Predictors of Postoperative Myocardial Infarction or Ischemia in Patients Undergoing Noncardiac Surgery

Among hypertensive and diabetic patients undergoing elective noncardiac surgery, preoperative status and intraoperative changes in mean arterial pressure (MAP) were evaluated as predictors of postoperative ischemic complications. Of 254 patients evaluated before operation and monitored during operation, 30 (12%) had postoperative cardiac death, ischemia, or infarction. Twenty-four per cent of patients with a previous myocardial infarction or cardiomegaly had an ischemic postoperative cardiac complication. Only 7% of those without either of these conditions sustained an ischemic complication. No other preoperative characteristics, including the presence of angina, predicted ischemic cardiac risk. Nineteen per cent of patients who had 20 mm Hg or more intraoperative decreases in MAP lasting 60 minutes or more had ischemic cardiac complications. Patients who had more than 20 mm Hg decreases in MAP lasting 5 to 59 minutes and more than 20 mm Hg increases lasting 15 minutes or more also had increased complications (p less than 0.03). Changes in pulse were not independent predictors of complications and the use of the rate-pressure product did not improve prediction based on MAP alone. In conclusion patients with a previous infarction or radiographic cardiomegaly are at high risk for postoperative ischemic complications. Prolonged intraoperative increases or decreases of 20 mm or more in MAP also resulted in a significant increase in these potentially life-threatening surgical complications.