Risk Factors For Hospital Mortality Research Articles

Risk analysis for hospital mortality after operations for type A aortic dissection

To analyze the risk factors for hospital mortality after operations for type A aortic dissection. Totally 766 consecutive patients (586 male and 180 female patient, aged (45±12) years, ranging from 16 to 78 years), who underwent surgery for type A aortic dissection from January 2001 to December 2010, were studied retrospectively. Preoperative and operation related clinic factors were analyzed by univariate analysis, followed by Logistic regression model, to identify the risk factors of hospital mortality. Overall, 37 patients (4.8%) died during hospitalization. On univariate analysis, significant risk factors for hospital mortality were male, acute status, renal dysfunction, cardiac dysfunction, cardiopulmonary bypass time, duration of operation, volume of blood transfusion, re-operation for bleeding (χ2=4.008-27.093, P<0.05). On Logistic regression model, independent risk factors were acute status (OR=2.784, 95%CI: 1.166-6.649, P=0.021), renal dysfunction (OR=6.285, 95%CI: 1.738 - 22.723, P=0.005), cardiac dysfunction (OR=3.052, 95%CI: 1.083-8.606, P=0.035), re-operation for bleeding (OR=3.690, 95%CI: 1.262-10.791, P=0.017), volume of blood transfusion (OR=1.033, 95%CI: 1.008-1.058, P=0.010). Additionally, male (OR=0.387, 95%CI: 0.177-0.848, P=0.018) was protective factor, and alternatively, female was indeed one of the independent risk factors for hospital mortality. Female, acute status, renal dysfunction, cardiac dysfunction, re-operation for bleeding, volume of blood transfusion were independent risk factors for hospital mortality after operations for type A aortic dissection.

Avaliação do tratamento cirúrgico da cardiopatia congênita em pacientes com idade superior a 16 anos

The increasing number of children with evolving congenital heart diseases demands greater preparation of professionals and institutions that handle them. To describe the profile of patients aged over 16 years with congenital heart disease, who have undergone surgery, and analyze the risk factors that predict hospital mortality. One thousand five hundred twenty patients (mean age 27 ± 13 years) were operated between January 1986 and December 2010. We performed a descriptive analysis of the epidemiological profile of the study population and analyzed risk factors for hospital mortality, considering the complexity score, the year in which surgery was performed, the procedure performed or not performed by the pediatric surgeon and reoperation. There was a significant increase in the number of cases from the year 2000. The average complexity score was 5.4 and the septal defects represented 45% of cases. Overall mortality was 7.7% and most procedures (973 or 61.9%) with greater complexity were performed by pediatric surgeons. Complexity (OR 1.5), reoperation (OR 2.17) and pediatric surgeon (OR 0.28) were independent risk factors influencing mortality. Multivariate analysis showed that the year in which the surgery was performed (OR 1.03), the complexity (OR 1.44) and the pediatric surgeon (OR 0.28) influenced the result. There is an increasing number of patients aged 16 years which, despite the large number of simple cases, the most complex ones were referred to pediatric surgeons, who had lower mortality, especially in recent years.

Open reconstruction of thoracoabdominal aortic aneurysms.

Technical details of our strategy for reconstructing the thoracoabdominal aorta are presented. Between October 1999 and June 2012, 152 patients underwent surgery for thoracoabdominal aortic aneurysms (Crawford classification type I =21, type II =43, type III =73, type IV =15). Mean age was 64.6±13.9 years. Sixty-three (41.4%) patients had aortic dissection, including acute type B dissection in 2 (1.2%) and ruptured aneurysms in 17 (11.2%). Eight (5.3%) patients had mycotic aneurysms, and 3 (2.0%) had aortitis. Emergent or urgent surgery was performed in 25 (16.4%) patients. Preoperative computed tomography (CT) scan or magnetic resonance (MR) angiography detected the Adamkiewicz artery in 103 (67.8%) patients. Cerebrospinal fluid drainage (CSFD) was performed in 115 (75.7%) patients and intraoperative motor evoked potentials were recorded in 97 (63.8%). One hundred and seven (70.4%) patients had reconstruction of the intercostal arteries from T7 to L2, 35 of which were reconstructed with the aortic patch technique and 72 with branched grafts. The mean number of reconstructed intercostal arteries was 3.1±2.5 pairs. Mild hypothermic partial cardiopulmonary bypass at 32-34 °C was used in 105 (69.1%) patients, left heart bypass was used in 4 (2.6%), and deep hypothermic cardiopulmonary bypass below 20 °C was used in 42 (27.6%). Thirty-day mortality was 9 (5.9%), and hospital mortality was 20 (13.2%). Independent risk factors for hospital mortality were emergency surgery (OR 13.4, P=0.003) and aortic cross clamping over 2 hours (OR 5.7, P=0.04). Postoperative spinal cord ischemia occurred in 16 (10.5%, 8 patients with paraplegia and 8 with paraparesis). Risk factors for developing spinal cord ischemic complications were prior surgery involving either the descending thoracic or the abdominal aorta (OR 3.75, P=0.05), diabetes mellitus (OR 5.49, P=0.03), and post-bypass hypotension <80 mmHg (OR 1.06, P=0.03). Postoperative survival at 5 years was 83.6±4.5%; 5-year survival was 47.5±8.6% in patients with spinal cord ischemia and 88.9±10.4% in those without spinal cord ischemia.

Impact of clinical severity index, infective pathogens, and initial empiric antibiotic use on hospital mortality in patients with ventilator-associated pneumonia

The prompt initial use of appropriate antibiotics should improve mortality rates in adults with ventilator-associated pneumonia (VAP). However, the incidence of multidrug-resistant (MDR) pathogen infections is on the rise, and the choice of the initial empiric antibiotic may be challenging. We investigated whether appropriate initial antibiotic therapy, infective pathogens, and the clinical severity index influence hospital mortality in patients with VAP and determined independent risk factors for the same. This study evaluated 163 adult patients (aged ≥ 18 years) at Chang Gung Memorial Hospital, Kaohsiung, Taiwan, from January 1, 2007, to January 31, 2008. Eligibility was evaluated based on criteria for VAP. Sequential Organ Failure Assessment (SOFA) scores, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) scores, oxygenation index, underlying comorbidities, septic shock status, previous tracheostomy status, and factors related to pneumonia were collected for analysis. Ninety-two patients survived from a total 163 patients with VAP during the course of their confinement in the intensive care unit. Multivariable logistic regression analysis identified that a pre-existing Charlson Comorbidity Index score (P = .011), initial oxygenation index (P = .025), SOFA score (P = .043), VAP caused by Acinetobacter baumanii (P = .030), and infection with MDR pathogens (P = .003) were independent risk factors for hospital mortality in patients with VAP. High Charlson Comorbidity Index score, high initial oxygenation index, high SOFA score, and infection with Acinetobacter baumannii or MDR pathogens significantly affect hospital mortality in patients with VAP.

Risk factors for hospital mortality in valve replacement with porcine bioprosthesis at an universitary institution

Study designed to identify characteristics of patients related to increased hospital mortality after valve replacement, assumed as risk factors. Retrospective study including 808 patients submitted to the implant of St. Jude Biocor porcine bioprosthesis between 1994 and 2009 at Instituto de Cardiologia do Rio Grande do Sul. Primary outcome was hospital death and hospital mortality was related to demographic and surgical characteristics. Statistics include t-test, qui-square test and logistical regression analysis. There were 80 (9.9%) hospital deaths. Risk factors identified with univariable logistical analysis (and respective odds-ratio) were: tricuspid surgery (OR 6.11); mitral valve replacement (OR 3.98); left ventricular ejection fraction < 30% (OR 3.82); diabetes mellitus (OR 2.55); atrial fibrillation (OR 2.32); pulmonary arterial hypertension (OR 2.30); serum creatinine > 1,4 mg/dL (OR 2.28); previous cardiac surgery (OR 2.17); systemic arterial hypertension (OR 1.93); functional class III e IV (OR 1.92); coronary bypass (OR 1.81); age > 70 years-old (OR 1.80); congestive heart failure (OR 1.73); e female gender (OR 1.68). Multivariable logistic regression for independent factors identified preponderant risk factors mitral valve replacement (OR 5,29); tricuspid surgery (OR 3.07); diabetes mellitus (OR 2.72); age > 70 years-old (OR 2.62); coronary bypass (OR 2.43); previous cardiac surgery (OR 1.82); e systemic arterial hypertension (OR 1.79). Mortality rate is within values found in literature. Identification of risk factors could contribute to changes in surgical indication and medical management in order to reduce hospital mortality.

In Patients With Acute Myocardial Infarction, the Impact of Hyperglycemia as a Risk Factor for Mortality Is Not Homogeneous Across Age-Groups

OBJECTIVETo assess the impact of hyperglycemia in different age-groups of patients with acute myocardial infarction (AMI).RESEARCH DESIGN AND METHODSA total of 2,027 patients with AMI were categorized into one of five age-groups: <50 years (n = 301), ≥50 and <60 (n = 477), ≥60 and <70 (n = 545), ≥70 and <80 (n = 495), and ≥80 years (n = 209). Hyperglycemia was defined as initial glucose ≥115 mg/dL.RESULTSThe adjusted odds ratios for hyperglycemia predicting hospital mortality in groups 1–5 were, respectively, 7.57 (P = 0.004), 3.21 (P = 0.046), 3.50 (P = 0.003), 3.20 (P < 0.001), and 2.16 (P = 0.021). The adjusted P values for correlation between glucose level (as a continuous variable) and mortality were 0.007, <0.001, 0.043, <0.001, and 0.064. The areas under the ROC curves (AUCs) were 0.785, 0.709, 0.657, 0.648, and 0.613. The AUC in group 1 was significantly higher than those in groups 3–5.CONCLUSIONSThe impact of hyperglycemia as a risk factor for hospital mortality in AMI is more pronounced in younger patients.

Abstract 8160: Risk Factors For Hospital Mortality And Morbidity Following The Norwood Procedure: Results From The Multicenter Single Ventricle Reconstruction Trial

BACKGROUND We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in a large prospective cohort of newborns with hypoplastic left heart syndrome and variants enrolled in the Single Ventricle Reconstruction trial. METHODS Potential predictors for outcome included patient and procedure related variables and center/surgeon volumes. Outcome variables occurring during the Norwood procedure and prior to hospital discharge or stage 2 surgery included: mortality, end-organ complications, length of ventilation and hospital length of stay (LOS). Variables with univariate p ≤ .2 were used as candidate predictors for multivariable regression modeling (p &lt; .05, significant). A reliability estimate of greater than 50% obtained by bootstrapping was required for terms to remain in the mortality model. RESULTS Analysis included 549 patients from 15 centers. Hospital mortality was 16% at a median of 16 (1 - 149) days after the Norwood procedure. Shunt type at the end of the Norwood procedure was not a significant risk factor for mortality during the Norwood hospitalization. Independent risk factors for mortality (n=88), renal failure (n=46), sepsis (n=93), length of ventilation among survivors (7 days, range 1 - 270) and hospital LOS among survivors (24 days, range 6 - 270) are shown in the Table. CONCLUSION Innate patient factors, pre-operative condition and lower center volume impact post-operative mortality and morbidity during the Norwood hospitalization.

Abstract 9251: Increasing Prevalence and Decreasing Mortality in Pulmonary Hypertension Related Hospitalizations in the United States: An Analysis of Over 20,000 Hospital Admissions

Introduction: Pulmonary hypertension (PH) is a serious but uncommon disorder. However, few large scale data exist on the prevalence or mortality associated with PH hospitalizations in children. Risk factors for hospital mortality are also unknown. Hypothesis: The prevalence of pediatric PH admissions has increased, but the mortality has decreased, over the 7-year period from 2000 - 2006. Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed for pediatric (age ≤ 20 years) PH related admissions for the years 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates. Results: In 2000 there were 7,348 (95%CI 6,176 to 8,521) pediatric PH related admissions and in 2006 there were 9,378 (95%CI 8,068 to 10,687) admissions (p&lt;0.001). Congenital heart disease was the most common associated diagnosis in all years (range 46.5% to 50.4%). Bronchopulmonary dysplasia (BPD) with PH increased over time from 4.2% in 2000 to 10.2% in 2006 (p&lt;0.001). Several comorbidities increased over time including sepsis, acute renal failure, and respiratory failure (p&lt;0.05 for all). Overall hospital mortality was greater for patients with PH (6.2%) compared to patients without PH (0.4%) (OR 17.7, 95%CI 16.1 to 19.4). Mortality for PH patients decreased over time from 7.7% in 2000 to 4.8% in 2006 (p&lt;0.001). Mortality was greatest among infants (8.2%), those with BPD (9.5%), respiratory failure (19.9%), renal failure (38.2%), and with extracorporeal membrane oxygenation (ECMO) (34.1%). On multivariable analysis, factors associated with increased mortality included earlier year (OR 2.0, 95% CI 1.6 to 2.5), respiratory failure (OR 4.5, 95% CI 3.6 to 5.7), ECMO (OR 4.8, 95% CI 3.1 to 7.4), and acute renal failure (OR 6.3, 95% CI 4.2 to 9.4). Conclusions: There were 2,000 more PH related hospitalizations in children in 2006 than in 2000. Comorbidities increased over this time period; however, hospital mortality decreased over 60%. These findings have critical implications for pediatric hospital utilization and planning. Increased off-label application of PH pharmacotherapeutic agents may have contributed to the improved survival.

Outcome Scoring Systems for Short-term Prognosis in Critically Ill Cirrhotic Patients

Cirrhotic patients admitted to intensive care units (ICUs) have high mortality rates. This study evaluated specific predictors and scoring systems for hospital and 6-month mortality in critically ill cirrhotic patients. This investigation is a prospective clinical study performed in a 10-bed specialized hepatogastroenterology ICU in a tertiary care university hospital in Taiwan. Two hundred two consecutive cirrhotic patients admitted to the ICU during a 2-year period were enrolled in this study. Demographic, clinical, and laboratory variables recorded on the first day of ICU admission and scoring systems applied were prospectively recorded for post hoc analysis for predicting survival. The overall hospital mortality was 59.9%, and the 6-month mortality rate was 70.8%. The main causes of cirrhosis were hepatitis B (29%), hepatitis C (22%), and alcoholism (20%). The major cause of ICU admission was upper gastrointestinal bleeding (36%). Multiple logistic regression analysis revealed that the Acute Kidney Injury Network (AKIN) score at the 48th hour of ICU admission and the Sequential Organ Failure Assessment (SOFA) as well as the Model for End-Stage Liver Disease scores on the first day of ICU admission were independent risk factors for hospital mortality. The SOFA score had the best discriminatory power (0.872 ± 0.036), whereas the AKIN had the best Youden index (0.57) and the highest correctness of prediction (79%). Cumulative survival rates at the 6-month follow-up after hospital discharge differed significantly (P < 0.05) for AKIN stage 0 vs. stages 1, 2, and 3, and for AKIN stage 1 vs. stage 3. The AKIN, SOFA, and Model for End-stage Liver Disease (MELD) scores showed well discriminative power in predicting hospital mortality in this group of patients. The AKIN scoring system proved to be a reproducible evaluation tool with excellent prognostic abilities for these patients.

Recent advancements of total aortic arch replacement

Recent advancements in total aortic arch replacement achieved by our approach were presented. From January 2002 to December 2010, 321 consecutive patients (mean age 69.8 ± 13.3 years) underwent total arch replacement through a median sternotomy at our institute. Aortic dissection was present in 94 (28.3%) patients and shaggy aorta in 36 (11.2%), with emergency/urgent surgery required in 106 (33.0%). Our current approach included the following: (1) meticulous selection of arterial cannulation site and type of arterial cannula; (2) antegrade selective cerebral perfusion; (3) maintenance of minimal tympanic temperature between 20 °C and 23 °C; (4) early rewarming just after distal anastomosis; (5) after 2004, bolus injection of 100 mg of sivelestat sodium hydrate into the pump circuit at the initiation of cardiopulmonary bypass; (6) after 2006, maintaining fluid balance below 1000 mL during cardiopulmonary bypass. Overall hospital mortality was 4.4% (14/321) and was 1.9% (4/215) in elective cases. Permanent neurologic deficit occurred in 4.4% (14/321) of patients and in 2.8% (6/215) of elective cases. Prolonged ventilation was necessary in 53 (16.5%), with a significant reduction after 2006 (22.8% vs 12.6%; P = .02). Multivariate analysis demonstrated that risk factors for hospital mortality were octogenarian (odds ratio, 4.32; P = .03), brain malperfusion (odds ratio, 21.2; P = .001) and cardiopulmonary bypass time (odds ratio, 1.01; P = .04). Survival at 3 and 5 years after surgery was 82.4% ± 2.5% and 78.5% ± 3.1%, respectively. Our current approach for total aortic arch replacement was associated with low hospital mortality and morbidities and with favorable long-term outcome.

Hyponatremia on admission to the emergency room as a risk factor for hospital mortality

Patients who develop hyponatremia during their hospitalization have higher hospital mortality. To determine if the presence of hyponatremia on admission to the emergency room is a risk factor for hospital mortality. Two hundred forty five patients consecutively admitted to the emergency room and then transferred to the Medicine Department, where they finally died, were matched for age and gender with 245 control subjects admitted to the emergency room and hospitalized in the Medicine Department at the same time, but survived. The dependent variable was death, and the exposure variable was hyponatremia. Admission diagnosis and Charlson comorbidity index was considered as confounding variables. Hyponatremia at admission occurred in 30 and 17% of patients who died and survived, respectively, rendering an adjusted odds ratio for death of 2.13 (95% confidence intervals = 1.27-3.57). Charlson Comorbidity Index according to age score was higher in subjects with hyponatremia compared to those without hyponatremia (8.1 ± 3.1 and 7.2 ± 2.8; p = 0.01). Multivariate analysis showed that age, gender, length of stay, cause of hospitalization and chronic diseases did not significantly modify the effect of hyponatremia on hospital mortality. Hyponatremia on admission at emergency room had a significant association with hospital mortality. Subjects with hyponatremia had a higher Charlson Comorbidity Index score.

Outcomes and Risk Factors for Mortality in Premature Neonates With Critical Congenital Heart Disease

We sought to describe contemporary outcomes and identify risk factors for hospital mortality in premature neonates with critical congenital heart disease who were referred for early intervention. Neonates who were born before 37 weeks' gestation with critical congenital heart disease and admitted to our institution from 2002 to 2008 were included in this retrospective cohort study. Critical congenital heart disease was defined as a defect requiring surgical or transcatheter cardiac intervention or a defect resulting in death within the first 28 days of life. Logistic regression analyses were performed to identify risk factors for mortality before hospital discharge. The study included 180 premature neonates, of whom 37 (21%) died during their initial hospitalization, including 6 (4%) before cardiac intervention and 31 (17%) after cardiac intervention. For the 174 patients undergoing cardiac intervention, independent risk factors for mortality were a 5 min Apgar score ≤ 7, need for preintervention mechanical ventilation, and Risk Adjustment in Congenital Heart Surgery category ≥ 4 or not assignable. Mortality for premature infants with critical congenital heart disease who are referred for early intervention remains high. Patients with lower Apgar scores who receive preintervention mechanical ventilation and undergo more complex procedures are at greatest risk.

SHA 025. Evaluation of the results of surgical intervention in patients with artificial heart valve dysfunction

Artificial heart valves are associated with a number of problems. This study included 20 patients who presented to the Cardiothoracic Surgery Department, Faculty of Medicine, University of Alexandria, with symptoms of artificial heart valve dysfunction. The aim of this study was to evaluate the results of surgical intervention in those patients. The overall mortality was 25%. Advanced NYHA classification and renal impairment were found to be risk factors for hospital mortality, as well as low ejection fraction, severe pulmonary hypertension, tricuspid disease, long cross clamp time, emergency operations and double valve replacement procedures.

SHA 011. Clinical care pathways for coronary surgery: Compliance to the ACC/AHA recommendations and its impact on early outcome

Objective: Coronary artery bypass grafting (CABG) in hemodialysis-dependent patients is associated with high mortality and morbidity rates. This retrospective study was undertaken to identify the risk factors for the 30 days mortality for hemodialysisdependent patients. Methods: Subjects included 85 consecutive hemodialysisdependent patients (63 men and 22 women), aged 50–87 years (mean age, 68 years), who underwent CABG. Operative procedures included CABG alone (n= 52) and CABG with valve replacement, repair, or others (n= 33). A series of peri-operative risk factors were subjected to univariate and multivariate analyses to identify the risk factors for the early mortality. Results: The overall 30 days mortality rate was 14.1% (12/85). Univariate analysis showed the following 4 risk factors to be statistically significant predictors of hospital death: a concomitant cardiac procedure, left ventricular ejection fraction <30%, emergency/urgent surgery, and anemia (hemoglobin <10 mg/dl) (p< 0.05 for each predictor). Multivariate logistic regression analysis however confirmed that a concomitant cardiac procedure (v = 15.090, p= 0.013) is the only statistically significant independent risk factors for hospital death. Conclusion: A concomitant cardiac procedure was identified as significant independent risk factors for hospital mortality after CABG in our population for hemodialysis-dependent patients. Therefore, these pre-operative risk factors may help in predicting operative risks and improving clinical outcomes in hemodialysisdependent patients undergoing CABG.

SHA 027. Outcome reporting and quality measurement in coronary artery bypass surgery at King Abdulaziz Cardiac Center

Artificial heart valves are associated with a number of problems. This study included 20 patients who presented to the Cardiothoracic Surgery Department, Faculty of Medicine, University of Alexandria, with symptoms of artificial heart valve dysfunction. The aim of this study was to evaluate the results of surgical intervention in those patients. The overall mortality was 25%. Advanced NYHA classification and renal impairment were found to be risk factors for hospital mortality, as well as low ejection fraction, severe pulmonary hypertension, tricuspid disease, long cross clamp time, emergency operations and double valve replacement procedures.

SHA 010. The early outcome of coronary artery bypass surgery in hemodialysis-dependent chronic renal failure patients

Objective: Coronary artery bypass grafting (CABG) in hemodialysis-dependent patients is associated with high mortality and morbidity rates. This retrospective study was undertaken to identify the risk factors for the 30 days mortality for hemodialysisdependent patients. Methods: Subjects included 85 consecutive hemodialysisdependent patients (63 men and 22 women), aged 50–87 years (mean age, 68 years), who underwent CABG. Operative procedures included CABG alone (n= 52) and CABG with valve replacement, repair, or others (n= 33). A series of peri-operative risk factors were subjected to univariate and multivariate analyses to identify the risk factors for the early mortality. Results: The overall 30 days mortality rate was 14.1% (12/85). Univariate analysis showed the following 4 risk factors to be statistically significant predictors of hospital death: a concomitant cardiac procedure, left ventricular ejection fraction <30%, emergency/urgent surgery, and anemia (hemoglobin <10 mg/dl) (p< 0.05 for each predictor). Multivariate logistic regression analysis however confirmed that a concomitant cardiac procedure (v = 15.090, p= 0.013) is the only statistically significant independent risk factors for hospital death. Conclusion: A concomitant cardiac procedure was identified as significant independent risk factors for hospital mortality after CABG in our population for hemodialysis-dependent patients. Therefore, these pre-operative risk factors may help in predicting operative risks and improving clinical outcomes in hemodialysisdependent patients undergoing CABG.

A Nationwide Analysis of Risk Factors for Hospital Mortality in Ulcerative Colitis Patients

A Nationwide Analysis of Risk Factors for Hospital Mortality in Ulcerative Colitis Patients

Evaluation of risk factors for hospital mortality and current treatment for poststernotomy mediastinitis

Poststernotomy mediastinitis (PSM) following cardiovascular surgery remains an intractable complication associated with considerable mortality. It is therefore necessary to assess the risk factors associated with hospital mortality and evaluate the surgical treatment options for PSM. We identified 59 (2.2%) patients who developed PSM after cardiovascular surgery between January 1991 and January 2010. PSM was defined as deep sternal wound infection requiring surgical treatment. In all, 31 patients were infected with methicillin-resistant Staphylococcus aureus (MRSA); and 14 patients died in hospital from PSM. A total of 51 patients were treated by simple closure or tissue flap reconstruction after débridement (traditional treatment), and 8 underwent closure or reconstruction after negative-pressure wound therapy (NPWT). The risk factors for in-hospital mortality due to PSM were analyzed by comparing the characteristics of survivors and nonsurvivors. The available surgical treatments for mediastinitis were also assessed. Univariate analysis identified age, sex, pulmonary disease, MRSA infection, prolonged mechanical ventilation and prolonged intensive care unit stay as risk factors for in-hospital mortality (P < 0.05). Multiple logistic regression analysis identified MRSA infection (odds ratio 20.263, 95% confidence interval 1.580-259.814; P = 0.0208) as an independent risk factor for hospital mortality. NPWT was associated with significantly less surgical failure than traditional treatment (P = 0.0204). There were no deaths as a result of PSM in patients who underwent NPWT irrespective of the presence of MRSA infection. MRSA infection was an independent risk factor for PSM-related in-hospital mortality. NPWT may improve the prognosis for patients with MRSA mediastinitis.

Do Elderly Patients Fare Well in the ICU?

A recent update of the Mortality Probability Model (MPM)-III found 14% of intensive care patients had age as their only MPM risk factor for hospital mortality. This subgroup had a low mortality rate (2% vs 14% overall), and pronounced differences were noted among elderly patients. This article is an expanded analysis of age-related mortality rates in patients in the ICU. Project IMPACT data from 135 ICUs for 124,885 patients treated from 2001 to 2004 were analyzed. Patients were stratified as elective surgical, emergency/unscheduled surgical, and medical and then further stratified by age and whether additional MPM risk factors were present or absent. Mortality rose with advancing age within all patient categories. Elective surgical patients without other risk factors were the least likely to die at all ages (0.4% for patients aged 18-29 years to 9.2% for patients aged ≥ 90 years), whereas medical patients with one or more additional risk factors had the highest mortality rate (12.1% for patients aged 18-29 years to 36.0% for patients aged ≥ 90 years). In these two subsets, mortality rates approximately doubled in the elective surgical group among patients aged in their 70s (2.4%), 80s (4.3%), and 90s (9.2%) but rose less dramatically in the medical group (27.0%, 30.7%, and 36.0%, respectively). Although mortality increased with age, the risk differed significantly by patient subset, even among elderly patients, which may reflect a selection bias. Advanced age alone does not preclude successful surgical and ICU interventions, although the presence of serious comorbidities decreases the likelihood of survival to discharge for all age groups.

Emergency thoracic surgery in elderly patients

ObjectivesEmergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients.DesignRetrospective chart review.SettingAcademic tertiary care referral center.ParticipantsEmergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany.Main outcome measuresCo-morbidities, mortality, risk factors and hospital length of stay.ResultsA total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ±6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency.ConclusionsOur study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality.