Risk Of Short-term Morbidity Research Articles

Neurological Surveillance in Moderate-Late Preterm Infants-Results from a Dutch-Canadian Survey.

Preterm birth remains an important cause of abnormal neurodevelopment. While the majority of preterm infants are born moderate-late preterm (MLPT; 32–36 weeks), international and national recommendations on neurological surveillance in this population are lacking. We conducted an observational quantitative survey among Dutch and Canadian neonatal level I–III centres (June 2020–August 2021) to gain insight into local clinical practices on neurological surveillance in MLPT infants. All centres caring for MLPT infants designated one paediatrician/neonatologist to complete the survey. A total of 85 out of 174 (49%) qualifying neonatal centres completed the survey (60 level I–II and 25 level III centres). Admission of MLPT infants was based on infant-related criteria in 78/85 (92%) centres. Cranial ultrasonography to screen the infant’s brain for abnormalities was routinely performed in 16/85 (19%) centres, while only on indication in 39/85 (46%). In 57/85 (67%) centres, neurological examination was performed at least once during admission. Of 85 centres, 51 (60%) followed the infants’ development post-discharge, with follow-up duration ranging from 1–52 months of age. The survey showed a wide variety in neurological surveillance in MLPT infants among Dutch and Canadian neonatal centres. Given the risk for short-term morbidity and long-term neurodevelopmental disabilities, future studies are required to investigate best practices for in-hospital care and follow-up of MLPT infants.

The Impact of Current Smoking and Smoking Cessation on Short-Term Morbidity Risk After Lumbar Spine Surgery.

A retrospective review of prospectively collected data. The aim of this study was to determine the impact of current smoking or prior smoking cessation on 30-day morbidity risk following lumbar spine surgery. Prior studies have reported conflicting data regarding the impact of smoking on morbidity risk, and few studies have investigated smoking cessation. A large, multicenter, prospectively collected clinical registry was queried for all adult patients undergoing lumbar spine surgery in 2012 and 2013, and 35,477 cases were identified. Morbidity data are collected by on-site clinical personnel for 30 days postoperatively. Patients were divided into categories of "never-smoker," for patients with no reported cigarette use (n = 27,246), "former smoker," for patients who quit smoking more than 12 months before surgery (n = 562), and "current smoker," for patients still using cigarettes (n = 7669). A univariate analysis was conducted to identify un-adjusted differences in morbidity risk, and a multivariate analysis was conducted in an attempt to control for confounders. In the multivariate analysis, current smokers had a significantly higher risk of both superficial surgical site infection and overall wound complications, than never-smokers (P < 0.05 for each). Current smokers also had a significantly higher risk of total 30-day morbidity (P = 0.04). There was a trend toward former smokers also having an increased risk, but this did not reach significance in any category. Patients with a pack-year smoking history of 1 to 20 pack-years and more than 40 pack-years both had a significantly higher risk of superficial surgical site infections (P < 0.05 for each). Current smoking is associated with a small but significant increase in systemic morbidity and wound complications following elective lumbar spine procedures. Increasing pack year history was also associated with wound complication risk, suggesting a dose-related effect. The data provide preliminary support for future studies on smoking cessation. 3.

Predictive Value of Rothman Index in Patients That Develop Febrile Neutropenia

Background: Febrile Neutropenia (FN) in cancer patients is associated with a high mortality rate yet identifying patients with FN at highest risk for short term morbidity and mortality remains challenging. The Rothman Index (RI) is a real-time composite measurement of a patient's condition using 26 clinical variables sensitive to signs of patient clinical decline. RI has been shown to predict intensive care unit (ICU) admission, hospital readmission and short term mortality among inpatients. A prior study from our institution demonstrated that hospitalized patients with hematological malignancies and RI < 60 have a greater likelihood of readmission or discharge to hospice rather than those with higher RI scores. The aim of this study was to explore RI as a predictor of adverse outcomes in patients with hematological malignancies who have FN.Methods: Chart records of all patients with hematological malignancies and FN who were hospitalized at Yale Cancer Center between February of 2013 and July of 2014 were reviewed. Clinical variables collected included demographics, malignancy type, comorbidities, admission condition and microbiological data related to the FN episode. The primary outcome measure was a composite of in-hospital mortality and discharge to hospice care. Variables associated with the primary outcome in univariate analysis were entered into a multivariate logistic regression model for analysis.Results: Of 308 patients with hematological malignancies, 180 (58.4%) developed FN during their admission and 38 (12.3%) died during the admission or were discharged to hospice. A total of 85 (27.6%) patients had a RI < 60, 155 (50.3%) had a RI between 60-80, and 71 (23.1%) had a RI > 80. Controlling for malignancy type, major medical comorbidities and microbiologically confirmed bacterial infection, RI < 60 was independently associated with this outcome (Odds ratio 3.02, 95% Confidence Interval 1.25-7.34). Baseline renal disease, pneumonia, respiratory failure and sepsis were also associated with the primary outcome.Conclusion: RI is an objective measure that can independently predict poor outcomes among inpatients with FN. RI can guide clinicians caring for patients with FN in both prognostication and identifying high risk patients with an RI < 60 who are at higher risk for mortality, discharge to hospice, or high risk of readmission. The utility of this scoring system should be compared to existing risk stratification systems used in Oncology to identify its optimal use in the clinical setting.Table 1Factors associated with inpatient mortality or hospice discharge among hematologic malignancy inpatients with febrile neutropeniaVariableOR95% CI for ORpRI < 603.021.25-7.34.015Respiratory Failure3.511.07-11.56.039Renal Disease4.971.38-17.9.014Sepsis8.181.63-41.2.011Pneumonia8.011.42-45.1.018 DisclosuresNo relevant conflicts of interest to declare.

CORR Insights®: What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases

Where Are We Now? Shoulder arthroplasty still needs a well-defined, accurate complication profile that can be discussed with our patients. The lack of such a profile is mainly due to the limited amount of shoulder arthroplasties done per year relative to the numbers of hip and knee arthroplasties and the limited numbers of outcomes studies. The current study by Anthony and colleagues is a great addition to the literature and is perhaps the largest series of patients studied looking at risk factors and complications. The authors found an 8% risk of short-term morbidity, with risk of transfusion and urinary tract infections topping the list of complications. Operative time greater than 2 hours, preoperative hematocrit less than 38, preoperative steroid use, and patients with congestive heart failure increase the risk of complications. Interestingly, morbid obesity did not affect the complication profile in this cohort of patients studied. With increased attention being focused on costs and outcomes, and with our reimbursement being closely tied to these values, we need more and better information about risk factors. Where Do We Need To Go? Shoulder arthroplasty has made great strides in recent years. The advent of anatomic shoulder systems, patient-specific technology, and reverse shoulder arthroplasty have greatly improved patient satisfaction and outcomes. With this improved technology, many more orthopaedists are performing shoulder replacement surgery. Therefore, it is imperative that we focus our energy on defining the actual risks of each type of shoulder replacement surgery to include primary, revision, reverse, and shoulder arthroplasty in the face of bone loss. Some important questions to definitively answer have been examined in this paper. Who should be performing shoulder arthroplasty? The authors define operative time greater than 2 hours as a risk for complication. Which patients will fare best undergoing this procedure? This paper outlines risk factors associated which increases complications. Does BMI, heart disease, diabetes, smoking, steroid use lead to unacceptable morbidity? What is the risk of DVT in upper extremity surgery? Does it warrant anticoagulation and if so, how aggressive should we be? What is the actual risk of bleeding for each type of shoulder arthroplasty? At what point should we recommend measures to mitigate the risk of transfusion such as preoperative blood donation or the use of transexamic acid? Is shoulder arthroplasty a viable candidate for outpatient surgery as seems to be the current trend in knee arthroplasty? How can we decrease the cost of this procedure while not compromising patient safety and outcomes? How Do We Get There? Without the benefit of databases, joint registries, and outcomes measures, those questions will remain unanswered. As more shoulder arthroplasties are performed, there will be a greater opportunity to define the risk and complication profile. In particular, we need to discern between anatomic total shoulder arthroplasty and reverse shoulder arthroplasty when looking at outcomes. In those databases that collect data by CPT code, this is not possible. A database that can scrutinize each type of shoulder replacement (hemiarthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty, revision to total, revision to reverse) would help us define the complications associated with each procedure. The participation of all surgeons who perform shoulder arthroplasties in joint registries would provide many more data points. In these registries, in addition to the procedure performed, it would be beneficial to collect data on the specifics of each procedure to include operative time, implant used, intraoperative blood loss, and intraoperative complications. Patient data to include preoperative comorbidities such as smoking, medical problems, BMI, preoperative hematocrit, age, sex to name a few. Surgeon data such as years in practice, fellowship training, number of shoulder arthroplasties done per year, hospital size, and location should be included. Finally, outcomes measures to evaluate objective and subjective results of the shoulder replacement should be collected. Once consistent measurements have been obtained, developing centers of excellence to address and mitigate potential risks and complications would standardize protocols, increase safely, minimize costs, and ultimately, improve outcomes.

Ethnicity-specific birthweight distributions improve identification of term newborns at risk for short-term morbidity

We aimed to determine whether ethnicity-specific birthweight distributions more accurately identify newborns at risk for short-term neonatal morbidity associated with small for gestational age (SGA) birth than population-based distributions not stratified on ethnicity. We examined 100,463 singleton term infants born to parents in Washington State between Jan. 1, 2006, and Dec. 31, 2008. Using multivariable logistic regression models, we compared the ability of an ethnicity-specific growth distribution and a population-based growth distribution to predict which infants were at increased risk for Apgar score <7 at 5 minutes, admission to the neonatal intensive care unit, ventilation, extended length of stay in hospital, hypothermia, hypoglycemia, and infection. Newborns considered SGA by ethnicity-specific weight distributions had the highest rates of each of the adverse outcomes assessed-more than double those of infants only considered SGA by the population-based standards. When controlling for mother's age, parity, body mass index, education, gestational age, mode of delivery, and marital status, newborns considered SGA by ethnicity-specific birthweight distributions were between 2 and 7 times more likely to suffer from the adverse outcomes listed above than infants who were not SGA. In contrast, newborns considered SGA by population-based birthweight distributions alone were at no higher risk of any adverse outcome except hypothermia (adjusted odds ratio, 2.76; 95% confidence interval, 1.68-4.55) and neonatal intensive care unit admission (adjusted odds ratio, 1.40; 95% confidence interval, 1.18-1.67). Ethnicity-specific birthweight distributions were significantly better at identifying the infants at higher risk of short-term neonatal morbidity, suggesting that their use could save resources and unnecessary parental anxiety.

778: Umbilical artery blood gas values in very preterm births and the risk of short-term morbidity

778: Umbilical artery blood gas values in very preterm births and the risk of short-term morbidity