Risk Factor For Prolonged Recovery Research Articles

Factors Associated With Prolonged Recovery After the Arterial Switch Operation for Transposition of the Great Arteries in Infants

This study aimed specifically to identify the predictors of prolonged recovery after the arterial switch operation for transposition of the great arteries in infants. The clinical records of all infants admitted to the surgical intensive care unit (SICU) between January 2000 and March 2011 after an arterial switch operation were retrospectively reviewed. The cohort was divided into a prolonged recovery group that included all patients who exceeded the 75th percentile for duration of SICU stay and a standard recovery group that included all the remaining patients. Of the 102 patients in the final analysis, 31 experienced prolonged recovery. The median SICU stay was 18 days (range, 14-58 days) for the patients in the prolonged recovery group and only 8 days (range, 5-13 days) for the patients in the standard recovery group. After univariate analysis, a stepwise logistic regression model analysis was used to compare the demographic data as well as the pre-, intra-, and postoperative variables between the two groups. Of all the variables analyzed, high postbypass serum lactate level [odds ratio (OR), 2.610; 95 % confidence interval (CI), 1.464-4.653; p = 0.039], need for larger volume of resuscitation fluid (OR, 3.154; 95 % CI, 1.751-5.682; p = 0.018), and noninfectious pulmonary complication (OR, 2.844; 95 % CI, 1.508-5.363; p = 0.025) were identified as independent risk factors for prolonged recovery among infants undergoing an arterial switch operation for transposition of the great arteries.

Factors Associated With Prolonged Recovery After the Fontan Operation

Mortality and major morbidity after the Fontan operation is low in the current era. However, factors contributing to prolonged postoperative recovery are not clearly understood. Data on all patients admitted to the cardiac intensive care unit (CICU) after a Fontan operation between June 2001 and December 2005 were retrospectively analyzed. We excluded all patients who died, required Fontan takedown, or required ECMO. The study cohort was further divided into a prolonged recovery group that included patients with >75%ile for duration of mechanical ventilation or pleural drainage, and a standard recovery group which included all other patients. A multivariable logistic regression model was used to compare demographic, anatomic, and physiological variables between the prolonged and standard recovery groups. There were 226 Fontan operations performed. Of the study population (n=218), the median age was 2.61 years (1.0 to 31.9 years) and weight was 12.45 kg (8.4 to 77.5 kg). The most common diagnosis was hypoplastic left heart syndrome (n=80, 36.7%). A systemic right atrioventricular valve was present in 139 (63.7%). The lateral tunnel fenestrated Fontan was the most common surgery (n=195, 89.4%). Within the study population, 81 (38%) patients meet criteria for prolonged recovery. Univariate risk factors for prolonged recovery included higher preoperative PVR (P=0.033), longer bypass times (P=0.009), higher postbypass lactate level (P=0.017), higher postoperative central venous (P<0.001) common atrial pressure (P=0.042), inotropic score (P<0.001), and need for greater volume resuscitation during the 24 postoperative hours (>75% for the entire group; P<0.001). In a multivariable model, need for greater volume resuscitation (OR 2.81, 95% CI 1.30, 6.05) was the only independent risk factor for prolonged outcome after the Fontan operation. High volume expansion in the early postoperative period is an independent risk factor for prolonged recovery. The need for high volume expansion may represent the compound effects of multiple risk factors including preoperative hemodynamics and a marked systemic inflammatory response to surgery and cardiopulmonary bypass, which in turn may mediate prolonged recovery.

Potential risk factors for prolonged recovery following whiplash injury.

A retrospective analysis of insurance data was made of 600 individuals claiming compensation for whiplash following motor vehicle accidents. Three hundred randomly selected claimants who had settled their injury claims within 9 months of the accident were compared with 300 who had settled more than 24 months after the accident. We compared the two groups to identify possible risk factors for prolonged recovery, for which settlement time greater than 24 months was a marker. Variables considered included demographic factors, type of collision, degree of vehicle damage, workers compensation, prior claim or neck disability, treatment and time to settlement. Consulting a solicitor was associated with a highly significant, four-fold increase of late settlement of the claim. A concurrent workers' compensation claim, prior neck disability and undergoing physiotherapy or chiropractic treatment were weakly associated with late settlement. The degree of damage to the vehicle (as indicated by cost of repairs) was not a significant predictor of late settlement. Late settlement may be the direct effect of legal intervention, independent of the severity of the injury. Whilst the financial benefit to the claimant of consulting a solicitor is apparent, the benefit of prolonged disability is not. It may be to the advantage of both insurers and claimants if those likely to proceed to late settlement could be recognised early and their claims settled expeditiously.