• Title, Summary, Keyword: Morbidity, mortality

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Perioperative Stroke, In-Hospital Mortality, and Postoperative Morbidity Following Transcatheter Aortic Valve Implantation: A Nationwide Study

  • Thirumala, Parthasarathy D.;Nguyen, Felix D.;Mehta, Amol;Schindler, John;Mulukutla, Suresh;Jeevanantham, Vinodh;Wechsler, Lawrence;Gleason, Thomas
    • Journal of clinical neurology
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    • v.13 no.4
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    • pp.351-358
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    • 2017
  • Background and Purpose Perioperative stroke is a significant complication of transcatheter aortic valve implantation (TAVI). This study aimed to quantify perioperative stroke as an independent risk factor for in-hospital mortality and postoperative morbidity in patients receiving TAVI. Methods A retrospective cohort study was conducted using the National Inpatient Sample. Patients undergoing TAVI during 2012 and 2013 were identified using diagnostic codes of International Classification of Diseases, ninth revision. Univariate and multivariate analyses were performed using patient demographics and comorbidities to identify predictors of mortality and morbidity, defined by a length of stay of >14 days and/or discharge to a place other than home. Results Data were obtained from 7,556 patients undergoing TAVI during 2012 and 2013. The incidence rates of mortality and morbidity were 4.57 and 71.12%, respectively. Perioperative stroke was an independent risk factor for mortality [odds ratio (OR)=3.182, 95% confidence interval (CI)=1.530-6.618, p=0.002], as were infection (OR=17.899, 95% CI=9.876-32.440, p<0.001) and pericardial tamponade (OR=7.272, 95% CI=2.874-18.402, p<0.001). Stroke also predicted morbidity (OR=5.223, 95% CI=2.005-13.608, p=0.001), which was also associated with age, being female, being Asian, moderate and high Van Walraven scores (VWR), and infection. Conclusions In conclusion, perioperative stroke was found to be independently associated with in-hospital mortality and postoperative morbidity, as are age and high VWR. Our findings support the use of further preoperative, intraoperative, and postoperative management strategies during TAVI.

Surgical Management of Unruptured Intracranial Aneurysms (비파열 뇌동맥류의 수술적 치료)

  • Ahn, Jae Sung;Kwon, Yang;Kwun, Byung Duk
    • Journal of Korean Neurosurgical Society
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    • v.29 no.3
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    • pp.330-335
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    • 2000
  • Objective : The purpose of this report is to assess the morbidity and mortality associated with clipping of intracranial unruptured aneurysms. Methods : At the authors' institution between May 1989 and December 1998, a total of 128 unruptured aneurysms in 110 patients were treated with surgical clippings. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : The main locations of the aneurysms were : middle cerebral artery 31%, internal carotid-posterior communicating artery 28%, anterior communicating artery 16%, paraclinoid 6.5%, internal carotid-anterior choroidal artery 7%, posterior circulation 7%. Forty three percent of the aneurysms were symptomatic and 57% asymptomatic. The overall outcome of the surgery was : Glasgow outcome scale(GOS) I 86%, GOS II 6%, GOS III 4.3%, GOS IV 0% and GOS V(death) 3.5%. The operative risk is higher for large to giant aneurysms, and for aneurysms in posterior circulations. Patients with non-giant aneurysm in anterior circulation showed no mortality, but morbidity of 8.2%, and in posterior circulation : 25% of mortality and 75% of morbidity. Patients with giant anterior circulation aneurysm have 22% of mortality and 22% of morbidity. For patients with giant posterior circulation aneurysm, mortality and morbidity were 25% and 25%, respectively. The postoperative deaths were related to occlusion of the major parent artery in 3 cases(75%). The postoperative morbidity was related to occlusion of artery(9/13), intraoperative rupture(3/13), and cranial nerve injury(1/13). Conclusion : This report documents 3.5% mortality and 13% of morbidity in the clipping surgery for unruptured intracranial aneurysms, and the relatively low risk of surgical clipping in non-giant and those located in anterior circulation. The natural history, especially risk of bleeding, of the unruptured intracranial aneurysms is still controversial. However, with respect to surgical results, unruptured non-giant aneurysm located in anterior circulation should be operated in patients with low risk.

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Mortality and Morbidity of Aneurysmal Neck Clipping during the Learning Curve

  • Lee, Sang-Ho;Hwang, Hyung-Sik;Moon, Seung-Myung;Kim, Sung-Min;Choi, Sun-Kil
    • Journal of Korean Neurosurgical Society
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    • v.40 no.1
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    • pp.16-21
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    • 2006
  • Objective : Young neurosurgeons need to focus on the mortality and morbidity of aneurysmal neck clipping to develop a personal experience with an initial series. Methods : Total 88 aneurysms from 75 patients who underwent neck clipping by the same operator from 2001 to 2004 were reviewed. Patients were divided into three groups : first year [Group I], second year [Group II], and third year [Group III] in each group. Location of aneurysm, age, Fisher grade, Hunter-Hess grade [H-H grade], postoperative Glasgow outcome scale [GOS], and complications related to surgical procedures were evaluated with Chi-square and logistic regression analyses. Results : Fourteen patients had complications related to surgery [18.7%]. The major causes of mortality and morbidity related to surgery were cerebral infarction, hemorrhage and brain swelling due to intraoperative rupture, brain retraction and vasospasm. Among the 4 cases of mortality were 2 patients in Group I, 1 patient in Group II and 1 patient in Group III, and location of aneurysms were 2 internal carotid artery[ICA] and 2 posterior communicating artery[PCoA] aneurysms. There were 4 morbidity and new neurological deficits in Group I, 4 in Group II and 2 in Group III. Although mortality and morbidity during the learning curve had a statistical significance in H-H grade, age [>60 years old], and aneurysm location [especially ICA aneurysm] as variables, mortality mainly occurred in ICA and PCoA aneurysms. Conclusion : Experienced supervision or endovascular approach should be considered for the treatment of ICA and PCoA aneurysms during the learning curve.

Human Health Risk Assessment Due to Air Pollution in the Megacity Mumbai in India

  • Maji, Kamal Jyoti;Dikshit, Anil Kumar;Chaudhary, Ramjee
    • Asian Journal of Atmospheric Environment
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    • v.11 no.2
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    • pp.61-70
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    • 2017
  • This study evaluated the human health risk in terms of the excess number of mortality and morbidity in the megacity Mumbai, India due to air pollution. AirQ software was used to enumerate the various health impacts of critical pollutants in Mumbai in past 22 years during 1992-2013. A relationship concept based on concentration-response relative risk and population attributable-risk proportion was employed by adopting World Health Organization (WHO) guideline for concentrations of air pollutants like $PM_{10}$, $SO_2$ and $NO_2$. For the year 1992 in Mumbai, it was observed that excess number of cases of total mortality, cardiovascular mortality, respiratory mortality, hospital admission due to COPD, respiratory disease and cardiovascular disease were 8420, 4914, 889, 149, 10568 and 4081 respectively. However, after 22 years these figures increased to 15872, 9962, 1628, 580, 20527 and 7905 respectively, but all of these reached maximum in the year 2006. From the result, it is also noted that except COPD morbidity the excess number of cases from 1992-2002 to 2003-2013 increased almost by 30%; and the excess number of mortality and morbidity is basically due to particulate matter ($PM_{10}$) than due to gaseous pollutants.

Mortality and Morbidity and Disease Free Survival after D1 and D2 Gastrectomy for Stomach Adenocarcinomas

  • Talaiezadeh, AH;Asgari, M;Zargar, MA
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.13
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    • pp.5253-5256
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    • 2015
  • Background: A number of randomized trials addressing alternative operative and multimodality approaches to gastric cancer have characterized early postoperative morbidity and mortality rates. The aim of this study was to compare mortality and morbidity and disease free survival after D1 and D2 gastrectomy for adenocarcinomas of the stomach Materials and Methods: From June 2006 to January 2012, patients were selected according to information of the cancer administrator center of Ahvaz Jundishapur Medical University. The inclusion criteria were age between 20-85 years and histologically proven adenocarcinoma of the stomach without evidence of distant metastasis. Patients were excluded if they had previous or coexisting cancer or disability disease. In this research, D1 was compared to D2 gastrectomy. Results: 131 patients were randomised, 49 allocated to D1 and 82 to D2 gastrectomy. The two groups were comparable for age, sex, site of tumors, and type of resection performed. The overall post-operative morbidity rate was 17.5%. Complications developed in 14.2% of patients after D1 and in 19.5% of patients after D2 gastrectomy (p=0.07). Postoperative mortality rate was 0.8% (one death); it was 2% after D1 and 0% after D2 gastrectomy. In this research disease free-survival after 3 years was 71.2 % with 63.2% after D1 and 76.8% after D2 gasterctomy. Conclusions: This study indicates that D2 gastrectomy with pancreas preservation is not followed by significantly higher morbidity and mortality than D1 resection. Based on the results of present study, D2 resection should be recommended as the standard surgical approach for resectable gastric cancer.

Analysis of morbidity, mortality, and risk factors of tracheostomy-related complications in patients with oral and maxillofacial cancer

  • Lee, Seung Tae;Kim, Min Gyun;Jeon, Jae Ho;Jeong, Joo Hee;Min, Seung Ki;Park, Joo Yong;Choi, Sung Weon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.38
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    • pp.32.1-32.6
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    • 2016
  • Background: This study aimed to analyze and describe the morbidity and mortality associated with tracheostomy in patients with oral cancer and to identify the risk factors associated with tracheostomy complications. Methods: We performed a retrospective chart review of patients who underwent tracheostomy during a major oral cancer resection between March 2001 and January 2016 at the National Cancer Center, Korea. Overall, we included 51 patients who underwent tracheostomy after oral cancer surgery. We assessed the morbidity and mortality of tracheostomy and determined the risks associated with tracheostomy complications. Results: Twenty-two tracheostomy-related complications occurred in 51 patients. The morbidity and mortality rates were 35.2 % (n = 18) and 0 % (n = 0), respectively. Tracheostomy-related complications were tracheitis (n = 4), obstructed tracheostomy (n = 9), displaced tracheostomy (n = 5), air leakage (n = 1), stomal dehiscence (n = 1), and decannulation failure (n = 2). Most complications (19/22) occurred during the early postoperative period. Considering the risk factors for tracheostomy complications, the type of tube used was associated with the occurrence of tracheitis (p < 0.05). Additionally, body mass index and smoking status were associated with tube displacement (p < 0.05). However, no risk factors were significantly associated with obstructed tracheostomy. Conclusions: Patients with risk factors for tracheostomy complications should be carefully observed during the early postoperative period by well-trained medical staff.

Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

  • Yoo, Ri Na;Kye, Bong-Hyeon;Kim, Gun;Kim, Hyung Jin;Cho, Hyeon-Min
    • Annals of Surgical Treatment and Research
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    • v.93 no.4
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    • pp.203-208
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    • 2017
  • Purpose: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. Methods: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. Results: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. Conclusion: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

Prognostic Factors Affecting Postoperative Morbidity and Mortality in Destroyed Lung (파괴폐의 술후 합병증과 사망에 영향을 미치는 예후 인자)

  • 홍기표;정경영;이진구;강경훈;강면식
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.35 no.5
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    • pp.387-391
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    • 2002
  • Background: Postoperative morbidity and mortality in destroyed lung are relatively high. We tried to identify the prognostic factors affecting postoperative morbidity and mortality in destroyed lung through a retrospective study. Material and method: The retrospective study was undertaken in 112 patients who had undergone pneumonectomy or pleuropneumonectomy for destroyed lung at Severance Hospital from 1970 to 2000. We analyzed the correlation between postoperative morbidity and mortality and etiology, duration of disease, preoperative FEV1, presence or absence of peroperative empyema, operation timing, the side of operation, duration of operation, and operation type. Result: There were 55 men and 57 women, aged 20 to 81 years (mean 44 years). Etiologic diseases were tuberculosis in 86 patients(76.8%) including tuberculos empyema in 20 and tuberculous bronchiectasis in 4, pyogenic empyema in 12(10,7%), bronchiectasis in 12(10.7%), and lung abscess in 2(1.8%). Postoperative morbidity were 25%(n=28) and postoperative mortality was 6%(n=7). The presence of preoperative empyema(p=0.016), pleuropneumonectomy(p=0.037) and preoperative FEV1 of less than 1.75 L(P=0.048) significantly increased the postoperative morbidity, If operation time was less than 300min, postoperative morbidity(p=0.002) and mortality(p=0.03) were significantly low. Conclusion: Postoperative morbidity and mortality in destroyed lung were acceptable. Postoperative morbidity and mortality were significantly low when operation time was less than 300 min. Preoperative existence of empyema, pleuropneumonectomy and preoperative FEV1 of less than 1.75 L significantly increased postoperative morbidity.

Risk Factors of Morbidity and Mortality after Coronary Artery Bypass Grafting (관상동맥우회로 이식술 후 이환과 사망의 위험요인)

  • 박창률;이응배;전상훈;장봉현;이종태;김규태
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.31 no.12
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    • pp.1159-1164
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    • 1998
  • Background: Although operative outcome is progressing due to the development of operative techniques and myocardial protection, some patients face an increased morbidity and mortality. Therefore, it has become increasingly important to predict the operative morbidity and mortality. Material and Method: This retrospective study reports the results of risk factor analysis of morbidity and mortality of 137 consecutive patients who were underwent coronary artery bypass graft surgery(CABG). Preoperative variables were age, sex, preoperative myocardial infarction, operative priority, left ventricular ejection fraction, obesity and triple vessel disease. Postoperative morbidities were arrhythmia, wound infection, cerebral infarction, prolonged postoperative hospitalization, pneumonia, acute renal failure, prolonged use of ventilator and operative death. Result: The mean age of total patients was 56.7 years, from 27 to 74. The overall mortality was 6.6%(9 of 137) with the mortality of 3.9%(5 of 128) for elective operation, and 44.4%(4 of 9) for emergent or urgent cases. The morbidity of patients over 65 years was stastistically higher than that of under 65 years. Sex distribution showed no difference in morbidity, however operative mortality rate was slightly higher in women (5/41, 12.19%) than in men(4/96, 4.17%). Morbidity of emergent or urgent operation was 100%, much higher than that of the elective operation. Mortality of the patients whose left ventricular ejection fraction was under 50% was higher than that of those over 50%. Conclusion: We concluded that the risk factors of morbidity after CABG were old age above 65 years and emergent or urgent operation, and that risk factors of mortality were low left venticular ejection fraction under 50% and emergent or urgent operation.

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FOOT AND MOUTH DISEASE AND ITS EFFECTS ON MORBIDITY, MORTALITY, MILK YIELD AND DRAFT POWER IN BANGLADESH

  • Chowdhury, S.M.Z.H.;Rahman, M.F.;Rahman, M.B.;Rahman, M.M.
    • Asian-Australasian Journal of Animal Sciences
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    • v.6 no.3
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    • pp.423-426
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    • 1993
  • A total 930 outbreaks of Foot and Mouth Disease (FMD) were recorded in Bangladesh from 1988 to 1991. Number of FMD outbreaks was recorded highest in Rajshahi division (304) followed by Dhaka (272), Khulna (203) and Chittagong (151). During 1988 to 1991, FMD outbreaks reached in peak level in 1990 (540) followed by 1989 (209), 1988 (95) and 1991 (86). Outbreaks though occurred throughout the year were higher in premonsoon and winter seasons. Morbidity rate was found significantly higher (p<0.01) in cattle (35.5%) than buffaloes (23.3%) and sheep/goats (4.8%). Of the cattle, bull/bullock infected more (p<0.01) than cows and calves. Morbidity rate in different animals was observed significantly higher (p<0.01) in Rajshahi and Dhaka divisions than in Khulna and Chittagong. Mortality specially in calves was found at the rate of 50.9%. Loss in milk yield was found to be 66.6%. Disease period for a FMD affected cattle varied from 16 to 26 days (average 22.7 days). Loss of working days per working cattle ranged from 14 to 24 days (average 21.2 days) and the loss in draft energy per cattle was found to be 12.7 to 18.9 KW hour.