Similarity between the ICU patient data acquired by the APACHE system and the patient outcomes data acquired by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) suggests that variables in NSQIP data could be effective mortality predictors. We theorized that identifying ACS-NSQIP preoperative data points predictive of patient outcomes would assist in identifying potential complications earlier.
Between 2006 and 2008 at the University of Maryland Medical Center, we identified 340 surgical ICU patients included in both databases as our study cohort. Median APACHE score calculation permitted division of study subjects into quartiles from which to examine length of stay, mortality variables, and ACS-NSQIP-recorded postoperative occurrences and preoperative risk factors. Outcomes were compared using each database's percentage of patients who had died.
Mortality was positively correlated with APACHE score increases. Initially, the average ICU length of stay increased, then declined. Most common postoperative occurrences were ventilator dependence >48 hours, pneumonia, unplanned intubation, sepsis, and septic shock. It was also noted that preoperative variables, such as American Society of Anesthesiologists classification and serum albumin levels, had an association with a poorer prognosis.
APACHE score predictions are consistent with ACS-NSQIP-recorded postoperative outcomes. Higher APACHE scores correlated with increased incidence of postoperative outcomes and were associated with earlier mortality in the most extremely ill. Poorer states of health before surgery also correlated with poor outcomes postoperatively.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: When high-risk lung transplant candidates are evaluated, nutritional state is often neglected. We evaluated the prevalence of markers reflecting pre-transplant malnutrition and their association with post-operative complications and death. METHODS: From January 2005 to July 2010, 453 patients underwent primary lung transplantation at our institution. Pre-operative nutrition-related variables, including body mass index and weight/height ratio, reflecting cachexia, and albumin, total protein, immunoglobulins, and absolute lymphocyte count were considered in identifying risk factors for time-related major post-operative complications (renal failure requiring dialysis, respiratory failure requiring tracheostomy), pulmonary or bloodstream infections, and death. RESULTS: Forty-eight patients had BMI <18.5 kg/m(2), 41 had a weight/height ratio ≤ 0.3, 102 had albumin <3.5 g/dl, 110 had total protein <6 g/dl, and 112 had an absolute lymphocyte count <1,000/μl, indicative of a malnourished state. At 6 months, 30% had experienced pulmonary infection, with lower total serum protein concentration an important risk (p = 0.02). One-year actuarial mortality was 15%; risk factors included lower serum albumin (p = 0.004), particularly when <3 g/dl. In contrast, variables reflecting nutritional state were not statistically significantly correlated with dialysis, respiratory failure requiring tracheostomy, or bloodstream infections. CONCLUSION: Although malnutrition is uncommon in lung transplant patients, those at extremes of low serum albumin and total protein have worse survival and increased risk of post-operative infection. Strategies to improve nutrition of these high-risk candidates awaiting lung transplantation should be developed.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 05/2013; 32(7). DOI:10.1016/j.healun.2013.04.005 · 6.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Model for End-Stage Liver Disease Sodium Model (MELD-Na) is a validated scoring system that uses bilirubin, international normalized ratio, serum creatinine, and sodium to predict mortality in cirrhotic patients awaiting liver transplantation. The aim of this study was to identify the utility of MELD-Na to predict patient outcomes, with and without liver disease, after elective colon cancer surgery.
A review of the American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2010) was conducted to calculate risk-adjusted 30-day outcomes using regression modeling.
A total of 10,842 patients (mean age, 68 years; 51% women) were included. MELD-Na scores were higher in men (10.2 vs 9.1, P < .001) and in open procedures (9.9 vs 9.1, P < .001). The overall complication and mortality rates were 26.3% and 3.3%, respectively. Incremental increases in MELD-Na score correlated with a 1.2% increase in mortality and a 1.1% increase in complications. On multivariate analysis, complications increased with MELD-Na score (odds ratio [OR], 1.05 per 1 point increase; 95% confidence interval [CI], 1.038 to 1.066). MELD-Na score was also associated with increased mortality (OR, 1.13; 95% CI, 1.1 to 1.16), along with ascites (OR, 5.7; 95% CI, 3.7 to 8.8) and corticosteroids (OR, 2.1; 95% CI, 1.3 to 3.3).
Elevated preoperative MELD-Na score is significantly associated with worse outcomes after elective resection for colon cancer.
American journal of surgery 11/2013; 207(4). DOI:10.1016/j.amjsurg.2013.06.008 · 2.29 Impact Factor
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