Nationwide Volume and Mortality after Elective Surgery in Cirrhotic Patients

Csikesz, Nicholas G.; Nguyen, Louis N.; Tseng, Jennifer F.; Shah, Shimul A.

doi:10.1016/j.jamcollsurg.2008.09.006

Cited by 154 publications

(126 citation statements)

References 13 publications

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“…For all patients with TJA, we also queried for patient demographics (age, sex, and race), insurance type, hospital type (urban academic, urban private, or rural), hospital size (large, medium, or small), region (Northeast, Midwest, South, and West), the 29 Elixhauser comorbidities [1] tracked by the NIS, length of stay, total hospital charges, and in-hospital mortality. The Elixhauser comorbidities index [12] has been used frequently in previous studies using NIS data [11,17,29]. Based on recent studies, the Elixhauser comorbidity index performs well in predicting outcome of patients [5,9,22] and based on the recent systematic review performed by Sharabiani et al [27], the Elixhauser comorbidity index seems to be one of the best comorbidity indexes for predicting outcome of patients in administrative databases.…”

Section: Methodsmentioning

confidence: 99%

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

Maltenfort

Morrison

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

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Background The prevalence of Clostridium difficile colitis is reportedly increasing in surgical patients and can negatively impact their outcome. However, as yet there are no clear estimates of the C difficile infection colitis rate and its consequences among patients undergoing total joint arthroplasty (TJA). Questions/purposes We asked: (1) What is the rate of C difficile colitis in TJA patients? (2) What are the risk factors of C difficile colitis in these patients? And (3) what is the effect of C difficile colitis on length of stay, in-hospital mortality, and estimated total charges? Methods Using ICD-9-CM diagnosis and procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing TJA for the years 2002 to 2010. Demographic data, comorbidities, occurrence of C difficile colitis, length of hospital stay, mortality, and hospital charges were extracted. Logistic regression was performed to identify predictors of C difficile colitis and its impact on in-hospital mortality.

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Section: Methodsmentioning

confidence: 99%

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

Maltenfort

Morrison

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

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“…Patients' comorbidities were determined using the ICD-9 codes for the 29 Elixhauser comorbidities, which are tracked in the NIS database from 2002 on [18]. The Elixhauser comorbidity index has been used frequently in previous studies using the NIS data [13,21,43]. Based on recent studies, the Elixhauser comorbidity index performs well in predicting the outcome of patients [7,11,27] and based on the recent systematic review performed by Sharabiani et al [42], the Elixhauser comorbidity index seems to be one of the best comorbidity indices for predicting outcome of patients in administrative databases.…”

Section: Methodsmentioning

confidence: 99%

Has the Rate of In-hospital Infections After Total Joint Arthroplasty Decreased?

Rasouli

Maltenfort

Purtill

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although infections are a major cause of morbidity and mortality after total joint arthroplasty (TJA), little is known about nationwide epidemiology and trends of infections after TJA. Questions/purposes We therefore determined (1) trends of postoperative pneumonia, urinary tract infection (UTI), surgical site infection (SSI), sepsis, and severe sepsis after TJA; (2) risk factors of these infections; (3) effect of these infections on length of stay (LOS) and hospital charges; and (4) the infection-related mortality rate and its predictors. Methods The International Classification of Diseases, 9 th Revision codes were used to identify patients who underwent TJA and were diagnosed with aforementioned infections during hospitalization in the Nationwide Inpatient Sample database from 2002 to 2010. Multivariate analysis was performed to identify risk factors of these infections. Results Rates of pneumonia, UTI, SSI, sepsis, and severe sepsis were 0.74%, 3.26%, 0.31%, 0.25%, and 0.15%, respectively. Number of comorbidities and type of TJA were independent predictors of infection. Mortality decreased during the study period (odds ratio, 0.87; 95% confidence interval, 0.86-0.89). The median LOS was 3 days without complications but increased in the presence of SSI (median, 7 days), sepsis (median, 12 days), and severe sepsis (median, 15 days). Occurrence of pneumonia, sepsis, and severe sepsis increased risk of mortality 5.2, 8.5, and 66.2 times, respectively. Conclusions Rates of UTI, pneumonia, and SSI but not sepsis and severe sepsis are apparently decreasing. The likelihood of infection is increasing with number of comorbidities and revision surgeries. Rate of sepsis-related mortality is also decreasing. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…Patients with LC are at a higher risk of liver-related complications during surgery due to inappropriate response to surgical stress. Mortality is higher in nonhepatic abdominal surgery in the presence of PHT, which is also an indicator of illness progression [10,15] . The presence of high intraoperative PHT is associated with postoperative mortality due to rebleeding [16] .…”

Section: Liver Functionmentioning

confidence: 99%

“…Surgery should ideally be elective, due to the higher than average risk associated with emergency surgery in cirrhotic patients [1,[7][8][9][10][11] . Careful tissue handling and meticulous surgical technique are vital to prevent major bleeding during surgery.…”

Section: Surgical Considerationsmentioning

confidence: 99%

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Outcomes of abdominal surgery in patients with liver cirrhosis

López-Delgado

Ballús

Esteve

et al. 2016

WJG

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Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and s p e c i a l i z e d a p p r o a c h c a n i m p r o v e o u t c o m e s ; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery.Key words: Liver cirrhosis; Outcomes; Coagulopathy; Nutritional status; Abdominal surgery; Adaptive levels of expertise of the surgeons, anesthetists, and intensive care unit (ICU) staff. Liver function is usually assessed by the Child-Turcott-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores [11] . Early studies found 30 d mortality rates after surgery were 10% in CTP-A, 30% in CTP-B, and 76%-82% in CTP-C, figures that have not significantly changed in more recent assessments [12,13] . Despite the poor results, advances in the medical management of LC and life expectancy have increased the eligibility of these patients for abdominal surgery [14] . To be able to give definitive recommendations and indications for non-hepatic abdominal surgery in the cirrhotic population, it is important to identify the patients most likely to benefit from it. There is also a need to assess contemporary surgical techniques and the various scoring systems currently in use.This review summarizes the outcomes of patients with LC undergoing non-hepatic abdominal surgery. Indexed articles in Medline of series of patients with LC who underwent non-hepatic abdominal surgery between 1950 and March 2014 were reviewed using the OVID interface. We aimed to select manuscripts addressing outcome based on the degree of LC assessed with MELD and/or CTP scores. Articles addressing the pathophysiology of cirrhotic patients and the clinical implications in non-hepatic abdominal surgery were selected based on their importance, their date of publication, and the citations of the manuscripts. As for articles describing the different types of surgery in LC patients, the most recent publications were selected in order to preser...

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Nationwide Volume and Mortality after Elective Surgery in Cirrhotic Patients

Cited by 154 publications

References 13 publications

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

Has the Rate of In-hospital Infections After Total Joint Arthroplasty Decreased?

Outcomes of abdominal surgery in patients with liver cirrhosis

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