Nurse working conditions were associated with all outcomes measured. Improving working conditions will most likely promote patient safety. Future researchers and policymakers should consider a broad set of working condition variables.

: Our proposed revised Baux score is simple enough for mental calculation, and its inverse logit transformation (provided with a calculator or nomogram) can provide precise predictions of mortality. Better predictions can be obtained using our more complex statistical model. Burn surgeons and nurses accustomed to using the original Baux score may welcome an updated version.

Background:The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods: This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results: Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two

Because the motor component of the GCS contains virtually all the information of the GCS itself, can be measured in intubated patients, and is much better behaved statistically than the GCS, we believe that the motor component of the GCS should replace the GCS in outcome prediction models. Because the m component is nonlinear in the log odds of survival, however, it should be mathematically transformed before its inclusion in broader outcome prediction models.

Background Although the incidence of sepsis is higher in men than women, it is controversial whether there are gender differences in sepsis-associated mortality. Objective To test the hypothesis that hospital mortality is higher in men compared to women with severe sepsis or septic shock and requiring intensive care. Methods Retrospective cohort study of 18,757 intensive care unit (ICU) patients, including 8,702 women (46%), with severe sepsis or septic shock in the Cerner Project IMPACT database. Results Hospital mortality was higher in women vs. men (35% vs. 33%, p = 0.006). After adjusting for differences in baseline characteristics and processes of care, women had a higher likelihood of hospital mortality than men (OR = 1.11, 95% CI = 1.04 – 1.19, p = 0.002). Women were less likely than men to receive deep venous thrombosis prophylaxis (OR = 0.90, 95% CI = 0.84 – 0.97), invasive mechanical ventilation (OR = 0.81, 95% CI = 0.76 – 0.86), and hemodialysis catheters (OR = 0.85, 95% CI = 0.78 – 0.93). Women were more likely than men to receive red blood cell transfusions (OR = 1.15, 95% CI = 1.09 – 1.22) and code status limitations (OR = 1.31, 95% CI = 1.18 – 1.47). Conclusions In this large cohort of ICU patients, women with severe sepsis or septic shock had a higher risk of dying in the hospital than men. This difference remained after multivariable adjustment. We also found significant gender disparities in some aspects of care delivery, but these did not explain the higher mortality in women.

T here is a strong association between a reduced estimated glomerular filtration rate (eGFR) and an increase in cardiovascular disease and all-cause mortality. Associations with morbidity in elective moderate-risk noncardiac surgery have not been examined. It was hypothesized that chronic kidney disease (CKD) would be associated with excess morbidity after elective, moderate-risk orthopedic surgery. Because they represent a large proportion of global surgical procedures and are characterized by highly homogeneous anesthetic and surgical practice, patients undergoing elective orthopedic joint replacement procedures were studied. Calculation of eGFR was done based on routine creatinine measurements using the Modification of Diet in Renal Disease equation. Chronic kidney disease was defined as eGFR G60 mL/min per 1.73 m 2 . Cardiac risk (Revised Cardiac Risk Index) and evidence-based preoperative factors associated with perioperative morbidity, such as operative time, blood loss, and perioperative temperature, were prospectively recorded using the postoperative morbidity survey. Differences in morbidity were analyzed between patients with CKD and normal preoperative renal function (W 2 test for trend) and presented as a hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (95% CIs). Secondary end points were time to hospital discharge and freedom from morbidities (analyzed by the log-rank test), both between and within CKD patients compared with those with normal renal function. Multiple regression analysis was performed to assess the association of CKD and perioperative factors with morbidity and length of hospital stay. A morbidity survey was conducted postoperatively in 526 patients undergoing elective orthopedic surgery. Chronic kidney disease patients (n = 142; 27%) sustained excess morbidity on postoperative day 5 (OR, 2.1 [95% CI, 1.2Y3.7]). It took longer (HR, 1.6 [95% CI, 1.2Y1.9]) for CKD patients to become free of morbidities (log-rank test). Time to hospital discharge was delayed by 4 days in CKD patients (HR, 1.4 [95% CI, 1.2Y1.7], log-rank test). Such patients sustained more pulmonary (OR, 2.2 [95% CI, 1.3Y3.6]), infectious (OR, 1.7 [95% CI, 1.1Y2.7]), cardiovascular (OR, 2.4 [95% CI, 1.2Y4.8]), renal (OR, 2.3 [95% CI, 1.5Y3.5]), neurological (OR, 4.3 [95% CI, 1.3Y17.7]), and pain (OR, 1.8 [95% CI, 1.03Y3.1]) morbidities.Additional stratification of CKD patients showed a preoperative eGFR of 50 mL/min per 1.73 m 2 or less to be associated with more frequent morbidity and a longer hospital stay, independent of age. Multiple regression analysis revealed CKD and congestive cardiac failure to be preoperative factors associated with a prolonged hospital stay. A sizable minority of CKD patients undergoing elective orthopedic procedures are at greater risk of prolonged morbidity and a longer hospital stay. Preoperative eGFR may enhance perioperative risk stratification beyond traditional risk factors. COMMENTIn recent years, the cardiovascular literature has focused on the relationship between C...

To explore the clinical impact and economic burden of hospital-acquired infections (HAIs) in trauma patients using a nationally representative database.

Unplanned readmissions in surgical patients are common in patients experiencing postoperative complications and can be predicted using the ACS NSQIP risk of major complications. Prospective identification of high-risk patients, using the NSQIP complication risk index, may allow hospitals to reduce unplanned rehospitalizations.