Debility Risk Model as a Predictor for Postsurgical Outcomes.

BACKGROUND: Decreased patient functional status is associated with higher rates of postoperative morbidity and mortality. The Vizient program recently implemented a debility risk model to identify patients with impaired functional status. We examined the relationship between this novel model and inpatient postsurgical outcomes in a large urban tertiary care center. METHODS: The Vizient database was accessed to compare surgical outcomes between patients coded with debility and patients without debility between January 2017 and December 2018. Data for each surgical specialty were obtained, and a chi-squared analysis was used to detect differences in readmission rates, mortality, and postoperative complications (defined by Vizient). These complications include pneumonia, postoperative infection, anesthesia complications, and shock. RESULTS: We found patients with debility have a higher mortality rate (3%) than patients without debility (2%) across all surgical specialties (P = .0103). Patients with debility have a higher 30-day readmission rate (16%) than those without debility (8%) across all specialties (P < .0001). Patients with debility had a higher rate of inpatient complications for neurosurgery (12.11% vs. 8%, P = .008), trauma surgery (11.9% vs. 6%, P =.025), general surgery (17.67% vs. 7%, P = .013), and cardiac surgery (47.06% vs. 18%, P =.0025). CONCLUSIONS: Our study supports the use of the Vizient debility code to predict postsurgical outcomes and risk stratify patients. By extension, functional status assessments in preoperative evaluation of patients remain important. Further, studies can build upon this data to measure the impact of preoperative, outpatient debility assessments in surgical patients.

Adherence to Inpatient Venous Thromboembolism Prophylaxis: A Single Institution's Concurrent Review.

Hospital-acquired venous thromboembolism (VTE) affects morbidity and mortality and increases health care costs. Poor adherence to recommended prophylaxis may be a potential cause of ongoing events. This study aims to identify institutional adherence rates and barriers to optimal VTE prophylaxis. The authors performed patient and nurse interviews and a concurrent review of clinical documentation, utilizing a cloud-based, HIPAA-compliant tool, on a convenience sample of hospitalized patients. Adherence and agreement between different assessment modalities were calculated. Seventy-six patients consented for participation. Nurse documented adherence was 66% (29/44), 44% (27/61), and 89% (50/56) for mechanical, ambulatory, and chemoprophylactic prophylaxis, respectively. Patient report and nurse documentation showed moderate agreement for mechanical and no agreement for ambulatory adherence (κ = 0.51 and 0.07, respectively). Concurrent review using a cloud-based tool can provide robust, timely, and relevant information on adherence to recommended VTE prophylaxis. Iterative concurrent reviews can guide efforts to improve adherence and reduce rates of hospital-acquired VTE.

Recognizing thyrotoxic hypokalemic periodic paralysis.

Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but potentially serious complication of thyrotoxicosis. The resulting muscle weakness is profound, associated with more severe hypokalemia, yet reversible. However, clinicians must be cautious because patients can develop life-threatening hyperkalemia during treatment. Underlying causes should be investigated as repeated episodes of THPP may occur.

Clinical utility of serum interleukin-8 and interferon-alpha in thyroid diseases.

Serum interleukin-8 (IL-8) and interferon-alpha (IFN-α) levels have been estimated from a total of 88 individuals of which 19 were disease-free healthy individuals, and 69 were patients with thyroid diseases: goitre (N = 21), autoimmune diseases (N = 16), and carcinomas (N = 32). Both IL-8 and IFN-α were significantly higher in all the patients as compared to healthy individuals. Serum IL-8 levels showed significant positive correlation with disease stage in thyroid cancer patients. Higher serum IL-8 levels were associated with advanced disease stage while no significant correlation was observed between serum IFN-α levels and any of the clinicopathological parameters. IL-8 and IFN-α significantly correlated with each other in anaplastic carcinoma patients. Finally concluding, monitoring the serum IL-8 and IFN-α levels can help differentiate patients with thyroid diseases from healthy individuals, and IL-8 seems to have a role in the pathogenesis of thyroid diseases and may represent a target for innovative diagnostic and therapeutic strategies.

Liver abscess within the first week of life in a very low birthweight infant.

Liver abscess is rare in neonates. The present report concerns a preterm neonate with history of antenatal laser ablation therapy (to prevent twin to twin transfusion syndrome), who developed liver abscesses within a few days of life. Conservative treatment with antibiotics led to the normalisation of inflammatory markers, leaving an echogenic (calcified) area in the liver.

Three-dimensional linear endoscopic ultrasound-feasibility of a novel technique applied for the detection of vessel involvement of pancreatic masses.

BACKGROUND: Endoscopic ultrasound (EUS) can reliably diagnose and stage pancreatic cancer but is less competent for the differentiation between vascular compression (VC) and invasion (VI). AIM: Prospective comparison of linear EUS with/without three-dimensional (3D) EUS for vessel involvement in pancreatic cancer to evaluate the feasibility of linear 3D ultrasound. MATERIAL AND METHODS: Linear echoendoscopy was used to identify the pancreatic tumor, the tumor-vessel relation and for EUS-FNA to obtain tissue diagnosis. Immediately afterwards, 3D image acquisition was performed using a magnetic tracked 3D sensor. The acquisition time was 10-20 s. RESULTS: EUS results of 22 patients with solid pancreatic lesions were compared to surgical histology. This proved adenocarcinoma in 17 patients and chronic pancreatitis in 5. EUS showed VI in 10 patients, VC in 6, and no vascular involvement (NVI) in 6. Additional 3D evaluation showed VI in 6 patients, VC in 10, and NVI in 6. Surgery proved VI in 7 patients, VC in 9, and NVI in 6. EUS showed VI in 3/5 patients with chronic pancreatitis, 3D showed VC only, while surgery found two patients to have VC and with NVI. In two patients with pancreatic cancer, VI was diagnosed on two dimensional (2D), but VC on 3D evaluation. Surgery showed VC and VI in one each. In the 2D, one patient with NVI had VI on surgery; and on 3D one VC proved to have NVI at surgery. In 1/22 patients the result of 3D was false negative, while 4/22 were false positives and one false negative in conventional EUS. CONCLUSION: Linear 3D EUS seems feasible for pancreatic evaluation. In addition, linear EUS enhanced the evaluation of vascular involvement of pancreatic lesions, especially in chronic pancreatitis.