Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate.

BACKGROUND: Comparative evaluation of surgical quality among hospitals must improve outcome and efficiency, and reduce medical costs. Reoperation after colorectal surgery is a consequence of surgical complications and therefore considered a quality-of-care indicator. With respect to the mortality rate, the 1-year mortality may be a more meaningful figure than in-hospital mortality, because it also reflects the impact of surgical complications beyond discharge. OBJECTIVE: The aim of our study was to evaluate the 1-year mortality after colorectal surgery and to identify predicting factors. DESIGN: This study was a retrospective analysis from our colorectal surgery database. PATIENTS: All patients who underwent elective colorectal surgery from 2005 to 2008 were included. MAIN OUTCOME MEASURES: Both univariate and multivariate analysis were performed to identify predicting factors. The following variables were analyzed: age, operative risk according to the ASA class, Charlson-Age Comorbidity Index, indication for and type of resection, primary anastomosis, tumor staging, anastomotic leakage, and reoperation. RESULTS: For 743 consecutive patients, the 1-year mortality rate was 6.9%. Patients were operated on mainly because of colorectal cancer (n = 537; 72%). The rate of reoperation and in-hospital mortality was 12.8% and 2.4%. Univariate survival analysis demonstrated that ASA class, age, Charlson-Age Comorbidity Index, reoperation, and stage of disease were independent predictors of 1-year mortality. Multivariate analysis showed that ASA class (P = .020; HR 1.69), age (P = .015; HR 2.08) and reoperation (P = .001; HR 2.72) are directly correlated with 1-year mortality. LIMITATIONS: Both patients with benign diseases and colorectal cancer are included. Furthermore, no clear guidelines on whether to perform a reoperation were available. CONCLUSION: One-year mortality after colorectal surgery is independently predicted by ASA class, age, and reoperation. Our results underline the value of the 1-year mortality rate and the reoperation rate as parameters for quality assessment in colorectal surgery.

Comparison of in vivo carotid 3.0-T magnetic resonance to B-mode ultrasound imaging and histology in a porcine model.

OBJECTIVES: We compared in vivo 3.0-T magnetic resonance (MR) images of the carotid artery wall in piglets to intima-media thickness measurements of similar carotid segments by B-mode ultrasound (US) and histology to define the corresponding anatomical tissue characteristics and accuracy of carotid MR images. BACKGROUND: Carotid MR is increasingly used for the assessment of cardiovascular risk and cardiovascular drug efficacy. Therefore, determining the anatomical correlate and accuracy of this modality is of major importance. METHODS: In vivo 3.0-T MR and B-mode US scans of the left and right common carotid arteries were performed in 5 piglets (75 to 80 kg). The T(1)-weighted MR images were acquired with a noninterpolated pixel size of 0.25 x 0.25 mm for mean wall area (MWA) and mean wall thickness measurements. The B-mode US measured common carotid intima-media thickness and common carotid diameter. We calculated US MWA using common carotid intima-media thickness and carotid diameter. In histology, the intima and media tissue area was defined as histology MWA. RESULTS: Histology MWA was 4.69 (standard deviation [SD]: 0.95) mm(2), MR MWA was 4.57 (SD: 0.41) mm(2), and US MWA was 4.90 (SD: 0.50) mm(2). The mean difference was 0.12 (SD: 1.11) mm(2) for MR and -0.21 (SD: 1.01) mm(2) for US when compared with histology. Bland-Altman analysis showed no systematic biases between MR, US, or histology. CONCLUSIONS: Absolute values for carotid artery histology, MR, and US measurements are in good agreement, indicating that both 3.0-T MR and B-mode US measurements can visualize the intima and media. Accuracy of 3.0-T MR is comparable to B-mode US. The present findings imply that carotid MR might be a novel asset in cardiovascular disease risk stratification and a valuable surrogate marker in cardiovascular prevention trials.