OBJECTIVE:To determine mortality, morbidity, and costs attributable to surgical-site infections (SSIs) in the 1990s.DESIGN: A matched follow-up study of a cohort of patients with SSI, matched one-to-one with patients without SSI.SETTING: A 415-bed community hospital. STUDY POPULATION: 255 pairs of patients with and without SSI were matched on age, procedure, National Nosocomial Infection Surveillance System risk index, date of surgery, and surgeon. OUTCOME MEASURES: Mortality, excess length of hospitalization, and extra direct costs attributable to SSI; relative risk for intensive care unit (ICU) admission and for readmission to the hospital.RESULTS: Of the 255 pairs, 20 infected patients (7.8%) and 9 uninfected patients (3.5%) died during the postoperative hospitalization (relative risk [RR], 2.2; 95% confidence interval [CI 95 ], 1.1-4.5). Seventy-four infected patients (29%) and 46 uninfected patients (18%) required ICU admission (RR, 1.6; CI 95 , 1.3-2.0). The median length of hospitalization was 11 days for infected patients and 6 days for uninfected patients. The extra hospital stay attributable to SSI was 6.5 days (CI 95 , 5-8 days). The median direct costs of hospitalization were $7,531 for infected patients and $3,844 for uninfected patients. The excess direct costs attributable to SSI were $3,089 (CI 95 , $2,139-$4,163). Among the 229 pairs who survived the initial hospitalization, 94 infected patients (41%) and 17 uninfected patients (7%) required readmission to the hospital within 30 days of discharge (RR, 5.5; CI 95 , 4.0-7.7). When the second hospitalization was included, the total excess hospitalization and direct costs attributable to SSI were 12 days and $5,038, respectively.CONCLUSIONS: In the 1990s, patients who develop SSI have longer and costlier hospitalizations than patients who do not develop such infections. They are twice as likely to die, 60% more likely to spend time in an ICU, and more than five times more likely to be readmitted to the hospital. Programs that reduce the incidence of SSI can substantially decrease morbidity and mortality and reduce the economic burden for patients and hospitals (Infect Control Hosp Epidemiol 1999;20:725-730).Each year, more than 18 million surgical procedures are performed in US hospitals. 1 The Centers for Disease Control and Prevention (CDC) estimates that 2.7% of these are complicated by surgical-site infections (SSIs), accounting for at least 486,000 nosocomial infections each year. 2 Such infections often lead to substantial morbidity and probably contribute to mortality in some patients. 3,4 However, the extent of morbidity and mortality attributable to SSI is not known. It is generally accepted that SSIs, like other nosocomial infections, prolong hospital stays and add to the economic costs of hospitalization. However, published estimates of the actual excess days and costs attributable to SSI reflect hospitalization patterns prior to the current era of diagnosis-related groups (DRGs) and managed care. [5][6][7][8][9][10][11] We conducted a ...

Seventy-six healthy adults underwent magnetic resonance imaging (1.5 T) to investigate the effects of age on regional cerebral volumes and on the frequency and severity of cortical atrophy, lateral ventricular enlargement, and subcortical hyperintensity. Increasing age was associated with (1) decreasing volumes of the cerebral hemispheres (0.23% per year), the frontal lobes (0.55% per year), the temporal lobes (0.28% per year), and the amygdala-hippocampal complex (0.30% per year); (2) increasing volumes of the third ventricle (2.8% per year) and the lateral ventricles (3.2% per year); and (3) increasing odds of cortical atrophy (8.9% per year), lateral ventricular enlargement (7.7% per year), and subcortical hyperintensity in the deep white matter (6.3% per year) and the pons (8.1% per year). Many elderly subjects did not exhibit cortical atrophy or lateral ventricular enlargement, however, indicating that such changes are not inevitable consequences of advancing age. These data should provide a useful clinical context within which to interpret changes in regional brain size associated with "abnormal" aging.

Background Paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia are recognized clinically when patients seek treatment for symptoms due to recurrent arrhythmias; atrial fibrillation also increases the risk of stroke. The frequency with which asymptomatic arrhythmias occur in patients with these arrhythmias is unknown.Methods and Results Twenty-two patients with paroxysmal atrial fibrillation (n=8) or paroxysmal supraventricular tachycardia (n=14) were studied for 29 days with two different ambulatory ECG-monitoring techniques to measure the relative frequency of asymptomatic and symptomatic arrhythmias. All class I antiarrhythmic drugs, calcium channel blockers, ,8-blockers, and digitalis were withheld. Sustained asymptomatic arrhythmia events (defined as lasting at least 30 seconds) were documented using continuous ambulatory ECG monitoring once weekly for a total of 5 of the 29 study days; symptomatic arrhythmia events were documented using transtelephonic ECG monitoring for all 29 days of the study. In the group of patients with paroxysmal atrial fibrillation, asymp-P aroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia are common arrhythmias that may be treated with antiarrhythmic drugs when patients have symptoms. Patients who are affected with these disorders have sinus rhythm that is punctuated by episodic recurrences of their arrhythmias. The sequence of these recurrent arrhythmia events can be described in mathematical terms as a "stochastic process," which is a series of events occurring in time in accordance with probabilistic laws.' In this study, we used methods developed to study stochastic processes to estimate the average rate of asymptomatic arrhythmia events in groups of patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. MethodsThe study sample consisted of 22 ambulatory outpatients (7 men and 15 women with mean±SD age of 47±+17 years) who were being followed in the Clinical Research Unit Arrhythmia Clinic because they had a paroxysmal supraventricular ar- tomatic arrhythmia events occurred significantly more frequently than symptomatic arrhythmia events; the mean rates, expressed as events/100 d/patient (95% confidence interval), were 62.5 (40.4, 87.3) and 5.2 (2.7, 9.0) (P<.01); the ratio of the mean rates was 12.1 (5.8, 26.4). In contrast, in the group of patients with paroxysmal supraventricular tachycardia, asymptomatic arrhythmia events were significantly less frequent than symptomatic arrhythmia events; the mean rates were 0.0 (0.0, 5.3) and 7.4 (5.0, 10.6) (P=.02). The ratio of the mean rates was 0.0 (0.0, 0.8).Conclusions In a group of patients with paroxysmal atrial fibrillation, sustained asymptomatic atrial fibrillation occurs far more frequently than symptomatic atrial fibrillation. However, it is not known whether asymptomatic atrial fibrillation is a potential risk factor for stroke even when patients are not having symptomatic arrhythmias. (Circulton. 1994;89:.224-227.) Key Words * a...