Significant Predictor Of Postoperative Mortality Research Articles

Perioperative mortality among geriatric patients in Ethiopia: a prospective cohort study.

With the dramatic growth in the aged population observed in developed and developing nations, the older population burdened by unmet demand for surgical treatment has become a significant yet unnoticed public health concern in resource-limited countries. Studies are limited regarding surgical mortality of geriatric patients in Africa. Therefore, this study aims to estimate the incidence and identify predictors of postoperative mortality using prospective data in a low-income country, Ethiopia. A prospective cohort study was conducted from June 01, 2019, to June 30, 2021, at a tertiary-level hospital in Ethiopia. Perioperative data were collected using an electronic data collection tool. Cox regression analysis was used to identify predictor variables. The association between predictors and postoperative mortality among geriatrics was computed using a hazard ratio (HR) with a 95% confidence interval (CI); p-value <0.05 was a cutoff value to declare statistical significance. Of eligible 618 patients, 601 were included in the final analysis. The overall incidence of postoperative mortality among geriatrics was 5.16%, with a rate of 1.91 (95% CI: 1.34, 2.72) deaths per 1,000 person-day observation. Age ≥ 80 years (Adjusted hazard ratio (AHR) = 2.59, 95% CI: 1.05, 6.36), ASA physical status III/IV (AHR = 2.40, 95%CI 1.06, 5.43), comorbidity (AHR = 2.53, 95% CI: 1.19, 7.01), and emergency surgery (AHR = 2.92, 95% CI: 1.17, 7.27) were the significant predictors of postoperative mortality among older patients. Postoperative mortality among geriatrics was high. Identified predictors were age ≥ 80 years, ASA status III/IV, comorbidity, and emergency surgery. Target-specific interventions should be addressed to improve high surgical mortality in these patients.

Incidence and predictors of perioperative mortality in a low-resource country, Ethiopia: a prospective follow-up study

ObjectiveThis study aimed to assess the incidence and identify predictors of perioperative mortality among the adult age group at Tibebe Ghion Specialised Hospital.DesignA single-centre prospective follow-up study.SettingA tertiary hospital in...

Relationship Between Risk, Nutritional Status and Functional Capacity and Clinical Outcomes in Cancer Patients: A Systematic Review

Abstract Objectives To systematically review the published evidence on nutritional risk screening instruments, nutritional assessment and functional capacity used in hospitalized cancer patients and possible associations with unfavorable clinical outcomes. Methods A systematic search was performed in EMBASE, PubMed/MEDLINE, LiLACS and SciELO (publications from January 2010 to January 2021) databases by search terms related to “nutritional risk”, “nutritional assessment”, functional capacity” and “cancer”. Results 3753 articles were identified, and 321 duplicates were excluded. Of the 3432 articles analyzed by title/abstract, 109 were selected for full reading and 28 studies meeting the inclusion criteria. The agreement analysis between the researchers generated a Kappa of 0.813. The evaluated studies included comparison of tools: 1) nutritional screening, 2) nutritional screening based on laboratory parameters, 3) nutritional assessment, 4) nutritional diagnosis and, 5) functional capacity. The higher nutritional risk, worst nutritional status and low functional capacity assessed by the Nutritional Risk Screening 2002 (NRS- 2002), Patient-Generated Subjective Global Assessment (PG-SGA); Subjective Global Assessment (SGA) and lower handgrip strength, respectively, were associated with longer of hospital stay. The worst nutritional status, identified by the SGA scores, Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Index (NRI) were significant predictors of postoperative mortality. Conclusions The studies included in this systematic review showed that higher nutritional risk, worse nutritional status and low functional capacity are associated with unfavorable outcomes such as longer hospital stay and mortality. The combination of the tools can be recommended for a complete assessment of the nutritional status of hospitalized cancer patients. Funding Sources Fundo de Incentivo à Pesquisa (FIPE) do Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil. (number# 2019/0708).

MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation.

Venovenous extracorporeal membrane oxygenation (VV ECMO) is increasingly being used in the management of severe acute respiratory distress syndrome (ARDS). The Respiratory ECMO Survival Prediction (RESP) score is most commonly used to predict survival of patients undergoing ECMO. However, the RESP score does not incorporate renal and hepatic dysfunction which are frequently a part of the constellation of multiorgan dysfunction associated with ARDS. The Model for End-Stage Liver Disease (MELD) incorporates both liver and kidney dysfunction and is used in the risk stratification of liver transplant recipients as well as those undergoing cardiac surgery. The aim of this study was to assess the prognostic value of the MELD score in patients undergoing VV ECMO. Patients undergoing VV ECMO from 2016 to 2019 were extracted from our prospectively maintained institutional ECMO database and stratified based on MELD score. Baseline clinical, laboratory, and follow-up data, as well as post-ECMO outcomes, were compared. Of 71 patients, 50 patients (70.4%) had a MELD score <12 and 21 (29.6%) had a MELD score ≥12. The higher MELD score was associated with increased post-ECMO mortality but reduced risk of dialysis and tracheostomy. In multivariate analysis, higher MELD score (HR 1.35, 95% CI = 1.07-2.75), lower body surface area (HR 0.16, 0.04-0.65), RESP score (HR 0.75, 95% CI = 0.64-0.87), and platelet count (HR 0.99, 95% CI = 0.98-0.99), were significant predictors of postoperative mortality. We conclude that MELD score can be used complementarily to the RESP score to predict outcomes in patients with ARDS undergoing VV ECMO.

Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia

Spina bifida disproportionally affects low-and-middle-income countries. We describe myelomeningocele surgical outcomes in Zambia and predictors of postoperative complications and mortality. This 2-center retrospective cohort study includes children who underwent surgical treatment for myelomeningocele in Lusaka, Zambia from 2017 to 2019. Primary outcomes included mortality and 30-day postoperative complications. Seventy-five patients were identified. Median age at first neurosurgical evaluation was 9 days (interquartile range [IQR], 6-21) and at surgery was 21 days (IQR 15-36). Lumbosacral myelomeningocele was most common (73%, n= 54). At first preoperative evaluation, 28% of the neural tube defects were deemed infected (n= 21), and 30% were leaking cerebrospinal fluid (n= 21). Postoperatively, 7% of patients died (n= 5), whereas 31% experienced a complication (n= 23). Most common complications included wound dehiscence (n= 10, 42%) and wound purulence (n= 6, 25%). Median follow-up duration was 41 days (IQR, 6-128). On univariable analysis, mortality was significantly associated with shorter follow-up duration (5 days [IQR, 2-7] vs. 46 days [IQR, 12-132]; P= 0.02) and any complication (P < 0.001). No variable was significantly associated with postoperative complication; however, 2 variables that notably neared significance were preoperative infection of the lesion (P= 0.05) and longer surgical delay (P= 0.06). Most patients born with myelomeningocele in Zambia present for first neurosurgical evaluation after 1 week of age. Preoperative infection of the lesion and postoperative complications are relatively common, and complications are a significant predictor of postoperative mortality. Further investigation into preoperative efforts to mitigate risk of postoperative complications and mortality is warranted.

Insufficient future liver remnant and preoperative cholangitis predict perioperative outcome in perihilar cholangiocarcinoma

BackgroundMajor liver resection has evolved as the mainstay of treatment for patients with perihilar cholangiocarcinoma (pCCA). Here we assessed the suitability of preoperative future liver remnant (FLR) measurement to predict perioperative complications, since surgical morbidity and mortality are high compared to other malignancies. MethodsBetween 2011 and 2016, 91 patients with pCCA underwent surgery in curative intent at our institution. The associations of surgical complications with FLR and clinico-pathological characteristics were assessed using logistic regression analyses. Different methods of FLR assessment, the calculated-FLR (cFLR; ratio of FLR to total liver volume), standardized FLR (sFLR; ratio of FLR to liver volume estimated by body surface area) and FLR to bodyweight ratio (FLR/BW) were tested for validity. ResultsMultivariable analysis identified preoperative cholangitis (Exp(B) = 0.236; p = 0.030) as the single significant predictor of postoperative mortality and cFLR (Exp(B) = 0.009, p = 0.004) as the single significant predictor of major postoperative morbidity (Clavien-Dindo ≥ 3b). Based on these findings we designed a futility criterion (cFLR<40% OR preoperative cholangitis) predicting in-house mortality. ConclusionsIn patients with pCCA, the preoperative FLR<40% as well as preoperative cholangitis are two risk factors to independently predict perioperative morbidity and mortality. The cFLR should be the preferred method of liver volumetry.

Gastrointestinal Bleeding After HeartMate II or HVAD Implantation: Incidence, Location, Etiology, and Effect on Survival.

The number of patients on destination therapy is increasing as long-term survival on continuous-flow left ventricular assist device (CF-LVAD) therapy has improved. Gastrointestinal bleeding (GIB) is a common complication after CF-LVAD implantation, and its risk correlates with longer support time, emphasizing the importance of GIB management. The lower pulsatility of CF-LVADs may promote arteriovenous malformations, which amplify the bleeding risk. Here, we retrospectively analyzed the location, incidence, and survival effect of GIB events in HeartMate II (HM-II) and HeartWare Ventricular Assist Device (HVAD) recipients to provide specific details regarding these complications. From November 2003 to March 2016, 526 patients with chronic heart failure underwent primary implantation of an HM-II (n = 403) or HVAD (n = 123) CF-LVAD at our center. Of the 526 patients, 140 (26.6%) had a GIB event (HM-II: n = 100; HVAD: n = 40), 92 (17.5%) had a single GIB event, and 48 (9.1%) had multiple GIB events (range: 2-9 events). HVAD recipients had a higher incidence of both upper and lower GIB events (p < 0.001 and P = 0.002, respectively) than HM-II recipients. Arteriovenous malformation was the most common etiology for GIB (50 patients/72 events); for this group, the average time-to-event was 300.4 days, the recurrence rate was 34%, and the 90-day and 1-year survival rates were 88.3% and 66.7%, respectively. Age at implantation was the only predictor of GIB. In conclusion, our study provides detailed information about GIB events associated with current CF-LVADs. Additional studies are required to evaluate strategies to reduce the incidence of GIB morbidity.

Mortality after abdominal emergency surgery in nonagenarians.

To search the pattern of diagnoses in nonagenarians undergoing emergency abdominal surgery between January 2009 and December 2013 in two hospitals. To test the hypothesis that pre-hospital functional status is an effective criterion for predicting postoperative mortality in nonagenarians after emergency abdominal surgery. The study is an observational study on 157 patients. Patients were identified from the operation database and perioperative data were extracted as prospectively information supplied by retrospective data from patient electronic files. The primary endpoints were short, middle and long-term mortality and the secondary endpoint was to identify preoperative factors associated with postoperative mortality. The most frequent reason for operation was intestinal obstruction. Overall mortality in the cohort was 34% (n = 54) after 30days and 54% (n = 84) after 1year. Amongst patients developing a serious complication (classified as Clavien Dindo class III or greater) after surgery (n = 45) the mortality was 80% (n = 36) after 30days and 89% (n = 40) after 1 year. In multivariate analysis, a high American Association of Anesthesiologists class (ASA) and a high Performance Status (PS) class (low performance) were significant predictors of post-operative mortality. Our data support pre-admission functional status for predicting postoperative mortality after emergency abdominal surgery in nonagenarians.

The maximum dimension of the inferior vena cava is a significant predictor of postoperative mortality in lung cancer patients with idiopathic interstitial pneumonia.

Several vascular measurements in computed tomography (CT) were reported to be indicators of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) patients. We evaluated the usefulness of these parameters as predictors of postoperative mortality in lung cancer patients with IIP. This retrospective study was performed on 1888 patients. The following CT findings were evaluated: diameter of the main pulmonary artery, ascending aorta, and the short axis of the inferior vena cava (IVC). Univariate and multivariate analyses were conducted to determine predictors of surgical mortality. In the IIP patients, the 90-day mortality was 0.8%, and the 2-year mortality was 5.8%. Regarding the 90-day mortality in patients with IIP, a multivariate analysis revealed a short axis of IVC > 21mm [odds ratio (OR) 6.4, p < 0.01) and the risk score reported by Japanese Association for Chest Surgery (JACS) (OR 1.4, p = 0.01) as independent predictors. Regarding the 2-year mortality in patients with IIP, a multivariate analysis revealed IVC > 21mm (OR 2.3, p < 0.04), %VC < 80% (OR 2.4, p = 0.02), and pathological cancer stages II and III vs. I (OR 7.2, p < 0.001) as independent predictors. Enlargement of the IVC as measured by CT was a significant predictor of mortality after surgery for lung cancer with IIP patients.

Early Mortality After Hip Fracture - Is Type of Surgery Important?

Introduction: Hip fractures are associated with an in-hospital mortality rate of 7-14%, and a profound impairment of independence and quality of life. Current guidelines indicate that surgery for hip fracture should be performed within 24 h of injury. The main purpose of this study was to determine which factors affect in-hospital mortality and the potential role of the anesthetist in its prevention. Methods: A retrospective, observational study of all patients submitted to hip fracture surgery during one year was carried out. Data were collected from medical records and linear regressions and a multivariate analysis with SPSS version 23.0 was run. Results: A total of 372 patients with the diagnosis of hip fracture submitted to surgery were included in this study. No correlation between waiting time for surgery and in-hospital mortality was found. In multivariate analysis, only increased ASA score (p=0,018) and having a fracture treated with an arthroplasty procedure (p=0,028) were statistically significant predictors of postoperative mortality. Conclusion: In our study, the statistically significant predictors of postoperative mortality were an increased ASA score and type of surgery (arthroplasty procedure). The surgical approach should always be a multidisciplinary decision, involving the anesthesiology and the orthopedic teams, and based on patient’s clinical state and not only the type of fracture.

Pre-burn malnutrition increases operative mortality in burn patients who undergo early excision and grafting in a sub-Saharan African burn unit

IntroductionIn the developed world, pre-existing malnutrition in the burn population influences operative outcomes. However, studies on pre-existing malnutrition and operative outcomes of burn patients in the developing world are lacking. We therefore sought to characterize the burn injury outcomes following operative intervention based on nutritional status. MethodsThis is a retrospective review of operative patients admitted to our burn unit from July 2011 to May 2016. Age-adjusted Z scores were calculated for height, weight, weight for height, and mid-upper arm circumference (MUAC). Following bivariate analysis, we constructed a fully adjusted logistic regression model of significant predictors of post-operative mortality, both overall and for specific age categories. ResultsOf the 1356 admitted patients, 393 received operative intervention (29%). Of those, 205 (52.2%) were male, and the median age was 6 years (3, 25), with 265 patients (67%) aged ≤16 years. The median TBSA was 15.4% (10%–25%) and open flames caused the majority of burns (64%), though in children under 5, scalds were the predominant cause of burn (52.2%). Overall mortality was 14.5% (57 patients) and ranged from 9.09% for patients aged 6–16, to 33.3% for adults ≥50years. Increased time from injury to operative intervention was protective (OR: 0.90, 95% CI: 0.83, 0.99). In post-operative patients with z-scores, increasing %TBSA burned (OR: 1.11, 95% CI: 1.05, 1.17) and increasing malnutrition (OR: 1.46, 95% CI: 1.03, 1.91) predicted death in the adjusted model. ConclusionPoor nutrition is an important risk factor for post-operative mortality in burned patients in resource-poor settings. Screening for malnutrition and designing effective interventions to optimize nutritional status may improve surgical outcomes in LMIC burn patients.

Short and medium-term outcomes for general surgery in nonagenarian patients in a district general hospital.

Introduction Surgeons are increasingly performing surgery on older patients. There are currently no tools specifically for risk prediction in this group. The aim of this study was to review general surgical operations carried out on patients aged over 90 years and their outcome, before comparing these with predictors of morbidity and mortality. Methods A retrospective review was carried out at our district general hospital of all general surgery patients aged over 90 years who underwent a general surgical operation over a period of 14 years. Information collected included demographics, details of procedures, P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), complications and outcomes. Results A total of 119 procedures were carried out, 72 involving entry into the peritoneal cavity. Overall, 14 patients (12%) died within 30 days and 34 (29%) died within one year. Postoperative complications included infection (56%), renal failure (24%), need for transfusion (17%) and readmission within 30 days (11%). Logistical regression analysis showed that the P-POSSUM correlated well with observed mortality and infection was a significant predictor of in-hospital mortality (p=0.003). Conclusions The P-POSSUM correlates significantly with outcome and should be used when planning major elective or emergency surgery in patients over 90 years of age. Infective complications appear to be a significant predictor of postoperative mortality. This study supports operative intervention as an option in this extreme age group but we emphasise the importance of appropriate patient selection and judicious clinical care.

Current Surgical Treatment for Thoracic Esophageal Cancer

Esophageal squamous cell carcinoma is the sixth most common cause of cancer death in Japan. Surgery was previously the mainstay of treatment, but because of high rates of local and systemic recurrence, multidisciplinary management is being evaluated. In this article, we introduce the recent addition of neoadjuvant chemotherapy to the surgical management of resectable esophageal squamous cell carcinoma, clinical stage II and III, following the randomized control trial JCOG 9907. Neoadjuvant chemoradiotherapy has recently been approved for esophageal squamous cell carcinoma because it offers an opportunity for marginnegative resection, improved locoregional control, and increased survival rate. Less-invasive endoscopic procedures, such as thoracoscopic esophagectomy and laparoscopy-assisted gastric tube reconstruction, are options for the resection of noninvasive esophageal cancer. We performed thoracoscopic esophageal mobilization with the patient in the prone position. Compared with esophagectomy with right trans-thoracotomy, thoracoscopic esophagectomy has the advantage of a lower incidence of respiratory complications, which are a significant predictor of postoperative mortality. Additionally, other recent surgical treatments are described.

Predictors of mortality after emergency or elective repair of abdominal aortic aneurysm in a Japanese population

In Japan, there has been virtually no study in a population large enough to definitively demonstrate a relationship between the preoperative clinical features and postoperative outcomes in patients undergoing abdominal aortic aneurysm (AAA) repair. The aim of this study was to determine the preoperative variables that significantly predict postoperative mortality after emergency or elective repair in Japanese patients with infrarenal AAA. In this retrospective cohort study, we assessed significant predictors of postoperative mortality in 1055 consecutive patients undergoing emergency (n = 186) or elective repair (n = 869) of an infrarenal AAA at the University of Tokyo Hospital or Sakakibara Heart Institute (Tokyo, Japan). Using logistic regression analysis, anemia (hemoglobin <9 g/dl), shock (systolic blood pressure <80 mmHg), and hypocholesterolemia (total cholesterol <120 mg/dl) were found to be independent preoperative predictors of 30-day mortality after emergency repair for ruptured AAA. The hazard ratio (HR) (95 % confidence interval) for these three predictors was 5.96 (1.70-20.84), 8.48 (1.47-49.02), and 7.31 (1.96-27.35), respectively. In the elective repair cases, no significant preoperative predictor of postoperative mortality could be identified either within or beyond 30 days of surgery. Hypocholesterolemia, anemia, and shock were found to be independent preoperative predictors of a postoperative high mortality rate in Japanese patients undergoing emergency repair for ruptured infrarenal AAA.

Validation of a Mayo post-operative mortality risk prediction model in Korean cirrhotic patients

Patients with cirrhosis have an increased risk of mortality after surgery. In 2007, a new model was suggested to calculate mortality risk at specific time points after surgery at the Mayo clinic. We investigated the mortality risks in Korean cirrhotic patients who underwent various surgeries and applied the Mayo clinic model to our study populations. We conducted a retrospective review of the charts of 160 patients with cirrhosis who underwent surgical procedures under general anaesthesia between January 1996 and December 2006 at two hospitals. The overall 30-, 90-day and 1-year mortality rates were 7.5, 9.4 and 10.6% respectively. In multivariate analysis, the Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) and the American Society of Anesthesiologists (ASA) physical status classification and age were significantly associated with mortality. The area under the receiver operating characteristic (AUROC) from the calculated value using Mayo model as a predictor of 30-, 90-day and 1-year mortality was 0.832, 0.803 and 0.822 respectively, of which, 1-year mortality was significantly different from AUROC of mortality prediction based on our patient's data (P=0.025). In addition, the mean of predicted 1-year mortality rate (22.6±12.0%) using Mayo model was significantly higher than that from observed (8.9±1.4%, P<0.01). The CTP score or MELD score or ASA physical class and age were found to be significant predictors of post-operative mortality in cirrhotic patients. The risk prediction model developed at the Mayo clinic showed good performance in Korean cirrhotic patients. However, we found that the model tended to overestimate mortality, especially 1 year after surgery.

Pancreatectomy risk calculator: an ACS-NSQIP resource

BackgroundThe morbidity of pancreatoduodenectomy remains high and the mortality may be significantly increased in high-risk patients. However, a method to predict post-operative adverse outcomes based on readily available clinical data has not been available. Therefore, the objective was to create a ‘Pancreatectomy Risk Calculator’ using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. MethodsThe 2005–2008 ACS-NSQIP data on 7571 patients undergoing proximal (n= 4621), distal (n= 2552) or total pancreatectomy (n= 177) as well as enucleation (n= 221) were analysed. Pre-operative variables (n= 31) were assessed for prediction of post-operative mortality, serious morbidity and overall morbidity using a logistic regression model. Statistically significant variables were ranked and weighted to create a common set of predictors for risk models for all three outcomes. ResultsTwenty pre-operative variables were statistically significant predictors of post-operative mortality (2.5%), serious morbidity (21%) or overall morbidity (32%). Ten out of 20 significant pre-operative variables were employed to produce the three mortality and morbidity risk models. The risk factors included age, gender, obesity, sepsis, functional status, American Society of Anesthesiologists (ASA) class, coronary heart disease, dyspnoea, bleeding disorder and extent of surgery. ConclusionThe ACS-NSQIP ‘Pancreatectomy Risk Calculator’ employs 10 easily assessable clinical parameters to assist patients and surgeons in making an informed decision regarding the risks and benefits of undergoing pancreatic resection. A risk calculator based on this prototype will become available in the future as on online ACS-NSQIP resource.

Influence of Tumor Peroxisome Proliferator-Activated Receptor γ and δ Expression on Postoperative Mortality of Patients Undergoing Colorectal Cancer Surgery

Purpose: To evaluate the influence of peroxisome proliferator-activated receptor γ (PPAR γ) and δ (PPAR δ) expression on postoperative mortality of patients with colorectal cancer (CRC). Methods: Optimal cutoff values were determined for each relative expression ratio (RER) (RER = PPAR expression of tumor/PPAR expression of normal mucosa) of PPAR, and patients were divided into two groups as follows (PPAR staging): patients with elevated RERs of PPAR γ (> 2.0) or PPAR δ (> 1.0) were termed Group H, and patients showing none of these elevated RERs of PPARs were termed Group L. Prognostic significance was analyzed by univariate and Kaplan–Meier analyses. Results: In total, 26 CRC patients were studied. Univariate analysis revealed that PPAR γ (> 2.0/ ≤ 2.0) (odds ratio, 11.43; 95% C.I., 1.154–113.1; p =. 0373), PPAR δ (> 1.0/ ≤ 1.0) (odds ratio, 15.00; 95% C.I., 1.503–149.7; p =. 0210) and PPAR staging (H/L) (odds ratio, 63.00; 95% C.I., 4.956–800.8; p =. 0014) were significant predictors of postoperative mortality. Kaplan–Meier analysis revealed that the survival curve of patients with CRC was clearly divided by PPAR staging (log rank test, p <.0001). Conclusions: Evaluation of PPAR γ and δ expression is useful for predicting postoperative mortality in patients undergoing CRC surgery.

Postoperative Mortality After Esophagectomy for Cancer: Development of a Preoperative Risk Prediction Model

Surgical resection for the treatment of esophageal cancer remains a high-risk procedure. To develop a model to predict risk of postoperative death, we sought to identify factors associated with postoperative mortality for Medicare patients undergoing esophagectomy for cancer. We evaluated patients in the Surveillance, Epidemiology, and End Results Program (SEER)-Medicare database who underwent esophagectomy for esophageal cancer from 1997 to 2003. Variables evaluated were patient age, race, marital status, sex, tumor stage, Charlson score, and hospital volume. Hospital volume was evaluated in tertiles of even volume groups (low, < .67 cases a year; medium, .68 to 2.33 cases a year; high, > 2.33 cases a year). The primary outcome measure was postoperative mortality, defined as death within 30 days of esophagectomy or death during the hospitalization in which the primary surgical procedure was performed. In-hospital deaths more than 30 days after esophagectomy were included in the outcomes to more accurately estimate the true mortality of this procedure. Multivariable logistic regression analyses were performed to evaluate the relationship between patient and provider characteristics and postoperative mortality. Finally, characteristics identified by the regression analysis were used to generate a simplified, clinically applicable model predicting risk of postoperative mortality in the Medicare population. A total of 1172 patients underwent esophageal cancer surgery during this study period. Overall postoperative mortality was 14%. Multivariable logistic regression demonstrated that age, Charlson score, and hospital volume were statistically significant predictors of postoperative mortality. The other variables such as race, martial status, sex, and disease stage were not found to be significant. The odds of postoperative mortality at low-volume hospitals were almost twice those at a high-volume hospital. Age greater than 80 increased odds of mortality almost twofold. Similarly, Charlson scores of > or = 2 resulted in more than a 1.5-fold risk of postoperative mortality. Our prediction model using these variables accurately stratified postoperative mortality for this population. Postoperative mortality (30-day and in-hospital) remains high after esophagectomy. Age, Charlson score, and hospital volume were identified as independent predictors of postoperative mortality. A simple risk prediction model that uses preoperative clinical data accurately predicted patient postoperative mortality for this SEER-Medicare population.

Association of allelic loss at 8p22 with poor prognosis among breast cancer cases treated with high-dose adjuvant chemotherapy

To identify specific allelic losses that might correlate with postoperative mortality of breast cancer patients treated with high-dose adjuvant chemotherapy consisting of cyclophosphamide, methotrexate and fluorouracil, we examined tumors from a cohort of 150 such patients, who were followed clinically for 5 years postoperatively, for allelic losses (loss of heterozygosity, LOH) among 18 microsatellite markers throughout the genome. Patients whose tumors had lost an allele at 8p22 had significantly higher risks of mortality than those whose tumors retained both alleles at those loci. At 8p22, the 5-year mortality rate was 31% among patients with losses vs. 8% with retention ( P=0.0354). No other region showed correlation between LOH and prognosis. The data indicate that LOH at 8p22 is a significant predictor of postoperative mortality for breast cancer patients who received high-dose postoperative adjuvant chemotherapy. Thus, LOH at 8p22 can serve as a negative prognostic indicator to guide postoperative management of patients.

Association of allelic losses at 3p25.1, 13q12, or 17p13.3 with poor prognosis in breast cancers with lymph node metastasis.

To identify specific allelic losses that might correlate with postoperative mortality of patients with node‐positive breast carcinomas, we examined tumors from a cohort of 263 such patients, who were followed clinically for 5 years postoperatively, for allelic losses among 18 microsatellite markers. Patients whose tumors had lost an allele at 3p25.1, 13q12, or 17p13.3 had significantly higher risks of mortality than those whose tumors retained both alleles at those loci. At 3p25.1, the 5‐year mortality rate was 33.8% among patients with losses vs. 16.8% with retention (P=0.0154); at 13q12,30.3% vs. 13.0% (P=0.0241); and at 17p13.3, 30.4% vs. 16.2% (P=0.0243). Combined losses at 3p25.1 and 17p13.3 increased the predicted postoperative mortality risk by a factor of 4.9 (5‐year mortality rate of 38.2% vs. 8.0%, P=0.0006), and combined losses at 3p25.1 and 13q12 raised the predicted postoperative mortality risks by a factor of 2.9 (34.7% vs. 12.7%, P=0.0441). These data indicate that loss of heterozygosity (LOH) at any one or a pair of loci at 3p25.1, 13q12, or 17p13.3 is a significant predictor of postoperative mortality for breast‐cancer patients.