Objective. Information on mortality after cholecystectomy in defined populations is limited. In this study we examined the case fatality rates and mortality ratios, based on register data. Material and methods. Hospit...Objective. Information on mortality after cholecystectomy in defined populations is limited. In this study we examined the case fatality rates and mortality ratios, based on register data. Material and methods. Hospital discharge and death certificate data were linked for all patients undergoing cholecystectomy in Sweden in 1987-99. Mortality risk was calculated as the standardized mortality ratio (SMR). Results. From 1 January 1987 to 1 December 1999, 123,099 patients underwent cholecystectomy for acute or chronic gallbladder disease. Between 1987-91 and 1995-99, the incidence of cholecystectomy increased by 13%, median age of patients decreased and the proportion of women increased. From 1995 to 1999, 32%of all cholecystectomies were completed as open cholecystectomy. During this period, 82%of patients aged 70 years or older with acute gallstone disease had an open cholecystectomy. For patients with chronic gallstone disease, the proportion was 43%. Postoperative crude mortality within 30 days for all patients was 0.4%. Patients with acalculous gallbladder disease had double the mortality risk compared with patients with calculous disease, and patients with acute cholecystitis had double the risk compared with patients with chronic disease. High age, previous hospital admission for conditions other than gallbladder disease, and cholecystectomy completed as an open procedure increased the risk, whereas gender and calendar year did not significantly affect the mortality risk. Biliary tract diseases accounted for 61%of all postoperative deaths, whereas 26%were due to cardiovascular diseases. Conclusions. During the 1990s, cholecystectomy incidence increased, whereas postoperative mortality risk remained unchanged. In order to further reduce the mortality risk, particular attention should be paid to elderly and frail patients and to patients with acalculous gallbladder disease.展开更多
OBJECTIVES: We assessed use of low-volume hospitals by race and ethnicity for major cardiovascular procedures and determined whether hospital volume is an important factor explaining racial and ethnic differences in p...OBJECTIVES: We assessed use of low-volume hospitals by race and ethnicity for major cardiovascular procedures and determined whether hospital volume is an important factor explaining racial and ethnic differences in post-procedure mortality. BACKGROUND: Low hospital volume predicts mortality for cardiovascular procedures and could be a mediator of racial and ethnic differences in procedure outcomes. METHODS: We analyzed data from 719,679 hospitalizations for cardiac artery bypass grafting(CABG), percutaneous transluminal coronary angioplasty(PTCA), abdominal aortic aneurysm(AAA) repair, and carotid endarterectomy(CEA)from 1998 to 2001 using the Nationwide Inpatient Sample. We used multivariate logistic regression to assess whether race predicts use of low-volume hospitals and the relative contribution of hospital volume to racial disparity in post-procedure in-hospital mortality. RESULTS: Black and Hispanic patients were more likely than white patients to receive cardiovascular procedures in low-volume hospitals. Black patients had greater risk-adjusted mortality than white patients after elective AAA repair(odds ratio[OR], 1.84;95% confidence interval[CI], 1.20 to 2.84), CABG(OR, 1.19; 95% CI, 1.06 to 1.33), and CEA(OR, 1.56; 95% CI, 1.07 to 2.27), but not PTCA. Hispanic patients did not have higher risk-adjusted mortality than white patients. Adjusting for hospital volume did not substantially reduce the relative risk of death for black patients compared with white patients. CONCLUSIONS: Black and Hispanic patients were more likely to receive cardiovascular procedures in low-volume hospitals, but hospital volume did not explain a large proportion of racial differences in post-procedure mortality. Additional research is needed to determine why black patients have increased mortality after cardiovascular procedures and how these mortality rates can be reduced.展开更多
目的分析急性A型主动脉夹层(acute type A aortic dissection,AAAD)伴灌注不良综合征(malperfusion syndrome,MPS)患者术后死亡的危险因素,为更合理制定临床治疗策略提供参考。方法回顾性分析2006年8月至2018年9月期间海军军医大学附属...目的分析急性A型主动脉夹层(acute type A aortic dissection,AAAD)伴灌注不良综合征(malperfusion syndrome,MPS)患者术后死亡的危险因素,为更合理制定临床治疗策略提供参考。方法回顾性分析2006年8月至2018年9月期间海军军医大学附属广州临床医学院连续手术的299例AAAD患者的临床资料,诊断合并MPS110例,其中术后死亡28例,纳入死亡组,82例存活患者纳入存活组。比较死亡组及存活组患者的围术期资料,将单因素分析有统计学意义的结果(P<0.05)纳入多因素Logistic回归,明确术后死亡独立危险因素,并采用受试者工作特征(receiver operating characteristic,ROC)曲线对所得危险因素的预测效能进行判断。结果单因素分析可得两组间患者的术前肌酐浓度、动脉血氧分压、急诊手术、肾脏灌注不良、2个以上脏器灌注不良、体外循环时间、主动脉阻闭时间、低流量脑灌注时间、脓毒症、连续肾脏替代治疗、恶性心律失常发生率比较,差异有统计学意义(均P<0.05)。将单因素比较有统计学意义的指标纳入二项分类Logistic回归分析,得出:2个以上脏器灌注不良、体外循环时间>240 min、主动脉阻闭时间>120 min和急诊手术是AAAD伴MPS患者术后死亡的独立危险因素。ROC曲线分析结果显示,联合预测概率的曲线下面积为0.896,有统计学意义(P<0.01),预测敏感性为92.9%,特异性为51.2%。结论AAAD患者术前伴MPS危害大,手术死亡率高。2个以上脏器灌注不良、体外循环时间>240 min、主动脉阻闭时间>120 min、急诊手术是AAAD伴MPS患者术后死亡的独立危险因素。展开更多
文摘Objective. Information on mortality after cholecystectomy in defined populations is limited. In this study we examined the case fatality rates and mortality ratios, based on register data. Material and methods. Hospital discharge and death certificate data were linked for all patients undergoing cholecystectomy in Sweden in 1987-99. Mortality risk was calculated as the standardized mortality ratio (SMR). Results. From 1 January 1987 to 1 December 1999, 123,099 patients underwent cholecystectomy for acute or chronic gallbladder disease. Between 1987-91 and 1995-99, the incidence of cholecystectomy increased by 13%, median age of patients decreased and the proportion of women increased. From 1995 to 1999, 32%of all cholecystectomies were completed as open cholecystectomy. During this period, 82%of patients aged 70 years or older with acute gallstone disease had an open cholecystectomy. For patients with chronic gallstone disease, the proportion was 43%. Postoperative crude mortality within 30 days for all patients was 0.4%. Patients with acalculous gallbladder disease had double the mortality risk compared with patients with calculous disease, and patients with acute cholecystitis had double the risk compared with patients with chronic disease. High age, previous hospital admission for conditions other than gallbladder disease, and cholecystectomy completed as an open procedure increased the risk, whereas gender and calendar year did not significantly affect the mortality risk. Biliary tract diseases accounted for 61%of all postoperative deaths, whereas 26%were due to cardiovascular diseases. Conclusions. During the 1990s, cholecystectomy incidence increased, whereas postoperative mortality risk remained unchanged. In order to further reduce the mortality risk, particular attention should be paid to elderly and frail patients and to patients with acalculous gallbladder disease.
文摘OBJECTIVES: We assessed use of low-volume hospitals by race and ethnicity for major cardiovascular procedures and determined whether hospital volume is an important factor explaining racial and ethnic differences in post-procedure mortality. BACKGROUND: Low hospital volume predicts mortality for cardiovascular procedures and could be a mediator of racial and ethnic differences in procedure outcomes. METHODS: We analyzed data from 719,679 hospitalizations for cardiac artery bypass grafting(CABG), percutaneous transluminal coronary angioplasty(PTCA), abdominal aortic aneurysm(AAA) repair, and carotid endarterectomy(CEA)from 1998 to 2001 using the Nationwide Inpatient Sample. We used multivariate logistic regression to assess whether race predicts use of low-volume hospitals and the relative contribution of hospital volume to racial disparity in post-procedure in-hospital mortality. RESULTS: Black and Hispanic patients were more likely than white patients to receive cardiovascular procedures in low-volume hospitals. Black patients had greater risk-adjusted mortality than white patients after elective AAA repair(odds ratio[OR], 1.84;95% confidence interval[CI], 1.20 to 2.84), CABG(OR, 1.19; 95% CI, 1.06 to 1.33), and CEA(OR, 1.56; 95% CI, 1.07 to 2.27), but not PTCA. Hispanic patients did not have higher risk-adjusted mortality than white patients. Adjusting for hospital volume did not substantially reduce the relative risk of death for black patients compared with white patients. CONCLUSIONS: Black and Hispanic patients were more likely to receive cardiovascular procedures in low-volume hospitals, but hospital volume did not explain a large proportion of racial differences in post-procedure mortality. Additional research is needed to determine why black patients have increased mortality after cardiovascular procedures and how these mortality rates can be reduced.
