Epidemiology in Anaesthesia Ii: Factors Affecting Mortality in Hospital

Farrow, Scott; Fowkes, F. G. R.; Lunn, J. N.; Robertson, I.; Samuel, Preethy S.

doi:10.1093/bja/54.8.811

Cited by 136 publications

(76 citation statements)

References 8 publications

(11 reference statements)

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“…Several articles have evaluated the efficacy and safety of ESD in elderly patients [30][31][32]; however, patients were only classified according to their age, and no other risk factors were considered. This is the first report to evaluate the safety of ESD in patients with co-morbidities according to their ASA status classification, which has become the most widely used patient perioperative risk assessment scheme in the field of anesthesiology [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate perioperative risk assessment is thus necessary for safe ESD. The American Society of Anesthesiologists (ASA) Physical Status Classification was developed as a means of defining preoperative risk, and a correlation between ASA classification and perioperative mortality has been reported [3,4]. In this study, we retrospectively evaluated the efficacy and safety of ESD for gastric neoplasms in patients with co-morbidities according to their ASA Physical Status Classification.…”

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confidence: 99%

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Endoscopic submucosal dissection for gastric neoplasm in patients with co-morbidities categorized according to the ASA Physical Status Classification

et al. 2012

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Background Endoscopic submucosal dissection (ESD) has come to be widely performed for reduced invasiveness; however, its safety in patients with co-morbidities is not fully examined. We aimed to evaluate the safety and efficacy of gastric ESD with co-morbidities categorized according to ASA Physical Status Classification. Methods Two hundred and forty patients of ASA 1 (no co-morbidities), 268 of ASA 2 (mild), and 19 of ASA 3 (severe) were treated by ESD for gastric neoplasms. We retrospectively compared clinicopathological features and treatment results of these three groups. Results Cases (by percent) treated with anticoagulant/ platelet agents were more common in the higher ASA grades (ASA 1, 5.8%; ASA 2, 29.1%; ASA 3, 31.6%; P \ 0.0001). There were no significant differences in case numbers treated under guideline criteria, curative resection (ASA 1, 79.6%; ASA 2, 79.9%; ASA 3, 78.9%), or complications related to the ESD procedure (e.g., postoperative bleeding, perforation, thermal injury). By a patient risk prediction model on surgery, i.e., P-POSSUM, morbidity was halved, and no patients died compared to a predicted death rate of 0.5-2%; however, total and complications unrelated to ESD procedure (e.g., aspiration pneumonia, ischemic heat attack) were more common in higher ASA grades (ASA 1, ASA 2, ASA 3: 15.4, 23.9, 26.3%, respectively, P = 0.014; 0.4, 7.1, 0%, respectively, P = 0.00087). Deviation rates from clinical pathway were more frequent and hospital stay (days) longer in higher ASA grades (ASA 1, ASA 2, ASA 3: 11.3, 17.9, 26.3%, respectively, P = 0.014; 8, 8, 9%, respectively, P = 0.0053). Conclusions ESD is an efficient treatment for gastric neoplasms with co-morbidities. However, additional caution is required because co-morbidity is a risk factor for both total complications and complications unrelated to the ESD procedure, and may cause deviations in the clinical course and prolonged hospital stay.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Endoscopic submucosal dissection for gastric neoplasm in patients with co-morbidities categorized according to the ASA Physical Status Classification

et al. 2012

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“…Our data are therefore in agreement with the two-hit theory of MOSD and, thus, reinforce the importance of investigating acute-phase proteins or cytokines during the perioperative period in patients who will undergo major operations. [3][4][5][6][7][8]17,23,26 Patients who are candidates for major operations on the abdominal cavity deserve attention because various factors, including previous bacterial infections, malnutrition and malignancies, for instance, may primarily trigger an immune system response. 23 Patients who are more prone to complications are also more reactive to operative trauma than o thers with a normal immune response.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the identifi cation of variables of interest for predicting the risk of postoperative infections has become the main objective of several reports. [3][4][5][6][7][8] Assessment of nutritional status and immune response may have prognostic value for such patients. It has been demonstrated that prior sensitization of the immune system may result in an inappropriate response to injury or infection.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of National Nosocomial Infection Surveillance score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery

et al. 2007

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were studied. The NNIS score and the evolution of serum IL-6 and various acute-phase proteins (C-reactive protein [CRP], albumin, prealbumin and transferrin) were correlated with postoperative infections and length of hospital stay (LOS). RESULTS:NNIS > 1 (p = 0.01) and low preoperative albumin (p = 0.02) signifi cantly correlated with infection. IL-6 and CRP increased significantly more in patients with infections. Multivariate analysis showed greater risk of infection when NNIS > 1 (odds ratio, OR = 10.66; 95% confi dence interval, CI: 1.1-102.0; p = 0.04); preoperative albumin < 3 g/dl (OR = 8.77; 95% CI: 1.13-67.86; p = 0.03); CRP > 30 mg/l on the second postoperative day (OR = 8.27; 95% CI: 1.05-64.79; p = 0.03) and > 12 mg/l on the fi fth postoperative day (OR = 25.92; 95% CI: 2.17-332.71; p < 0.01); and IL-6 > 25 pg/ml on the fi fth postoperative day (OR = 15.46; 95% CI: 1.19-230.30; p = 0.03). Longer LOS was associated with cancer, transferrin, IL-6 and albumin (p < 0.05).CONCLUSIONS: NNIS, albumin, CRP and IL-6 may be useful as predictive markers for postoperative infections. For predicting LOS, malignant condition, transferrin, albumin and IL-6 are useful.

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“…We used a combination of age, sex, physical status score, length of operation (as a proxy for surgical severity), and emergency status; these variables had been identified earlier as factors of significance to anaesthetic outcomes. [22][23][24] Further refinements in case-mix description will be necessary before more precise comparisons of outcome of anaesthetic care are possible. Nonetheless, it is unlikely that the five-fold magnitude of the differences seen here can be explained by lack of adjustment for yet to be defined variables.…”

Section: Discussionmentioning

confidence: 99%

The Canadian four-centre study of anaesthetic outcomes: II. Can outcomes be used to assess the quality of anaesthesia care?

et al. 1992

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Epidemiology in Anaesthesia Ii: Factors Affecting Mortality in Hospital

Cited by 136 publications

References 8 publications

Endoscopic submucosal dissection for gastric neoplasm in patients with co-morbidities categorized according to the ASA Physical Status Classification

Endoscopic submucosal dissection for gastric neoplasm in patients with co-morbidities categorized according to the ASA Physical Status Classification

Efficacy of National Nosocomial Infection Surveillance score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery

The Canadian four-centre study of anaesthetic outcomes: II. Can outcomes be used to assess the quality of anaesthesia care?

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