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1.
Bone ; : 115325, 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32201359

RESUMO

BACKGROUND: This study aimed to investigate the potential association of exposure to metformin therapy with the risk of hip fracture in adult patients with type II diabetes. We included patients with diabetes who were registered in the 2010 sample cohort database of the National Health Insurance Service in South Korea. METHODS: The patients who had been prescribed continuous oral metformin therapy for a 1-year period in 2010 were defined as the metformin group, while those who were not prescribed metformin during the same period were classified as the control group. The primary endpoint of this study was the development of hip fracture between January 2011 and December 2015. RESULTS: A total of 64,878 patients (31,300 patients in the metformin group and 32,439 patients in the control group) were included in this study. Among those, 1655 patients (2.6%) had experienced a hip fracture. After a propensity score matching, a total of 37,378 patients (18,689 patients in each group) were included in the analysis. Using a time-dependent Cox regression analysis on the propensity score-matched cohort, the exposure to metformin was not significantly associated with the development of hip fracture compared to the control group (hazard ratio: 1.00, 95% confidence interval: 0.86 to 1.16; P = 0.985). Similar results were observed using sensitivity analysis of a multivariable time-dependent Cox regression model of the entire cohort (hazard ratio: 0.78, 95% confidence interval: 0.36 to 1.69; P = 0.525). CONCLUSIONS: This population-based cohort study in South Korea showed that there was no significant association between the exposure to metformin therapy and hip fracture in patients with type II diabetes mellitus.

2.
J Anesth ; 2020 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-32146543

RESUMO

PURPOSE: There have been no large-scale studies on whether metformin therapy might have a potential benefit for lowering mortality. Thus, this study aimed to investigate the association between prior metformin therapy and the development of sepsis as well as the association between prior metformin therapy and 30-day mortality in sepsis patients. METHODS: We evaluated adult diabetes patients registered in the 2010 sample cohort database of the National Health Insurance Service in South Korea. Diabetes was identified according to the International Classification of Disease-10 diagnostic system (E10-E14). The cohorts were divided into the metformin user group (i.e., those who had been prescribed continuous oral metformin over a period of ≥ 90 days) and the control group (i.e., all other individuals). The primary endpoint was the development of sepsis between 2011 and 2015, and the secondary endpoint was 30-day mortality among diabetes patients diagnosed with sepsis. RESULTS: In total, 77,337 patients (34,041 in the metformin user group and 43,296 in the control group) were included in the analysis, among whom 2512 patients (3.2%) were diagnosed with sepsis between 2011 and 2015. After propensity score adjustment, metformin use was not significantly associated with both the risk of sepsis (OR: 0.92, 95%CI 0.82-1.03; P = 0.143) and the risk of 30-day mortality after diagnosis of sepsis (OR: 0.94, 95%CI 0.75-1.17; P = 0.571). CONCLUSIONS: Prior metformin therapy was not significantly associated with the risk of sepsis and 30-day mortality after diagnosis of sepsis among diabetes patients.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32168795

RESUMO

The high cost of treatment for acute respiratory distress syndrome (ARDS) is a concern for healthcare systems, while the impact of patients' socio-economic status on the risk of ARDS-associated mortality remains controversial. This study investigated associations between patients' income at the time of ARDS diagnosis and ARDS-specific mortality rate after treatment initiation. Data from records provided by the National Health Insurance Service of South Korea were used. Adult patients admitted for ARDS treatment from 2013 to 2017 were included in the study. Patients' income in the year of diagnosis was evaluated. A total of 14,600 ARDS cases were included in the analysis. The 30-day and 1-year mortality rates were 48.6% and 70.3%, respectively. In multivariable Cox regression model, we compared income quartiles, showing that compared to income strata Q1, the Q2 (P = 0.719), Q3 (P = 0.946), and Q4 (P = 0.542) groups of income level did not affect the risk of 30-day mortality, respectively. Additionally, compared to income strata Q1, the Q2 (P = 0.762), Q3 (P = 0.420), and Q4 (P = 0.189) strata did not affect the risk of 1-year mortality. Patient income at the time of ARDS diagnosis did not affect the risk of 30-day or 1-year mortality in the present study based on South Korea's health insurance data.

4.
BMC Anesthesiol ; 20(1): 41, 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32079528

RESUMO

BACKGROUND: Reversing a neuromuscular blockade agent with sugammadex is known to lessen postoperative complications by reducing postoperative residual curarization. However, its effects on 90-day mortality are unknown. Therefore, this study aimed to compare the effects of sugammadex and neostigmine in terms of 90-day mortality after non-cardiac surgery. METHODS: This retrospective cohort study analyzed the medical records of adult patients aged 18 years or older who underwent non-cardiac surgery at a single tertiary care hospital between 2011 and 2016. Propensity score matching and Cox regression analysis were used to investigate the effectiveness of sugammadex and neostigmine in lowering 90-day mortality after non-cardiac surgery. RESULTS: A total of 65,702 patients were included in the analysis (mean age: 52.3 years, standard deviation: 15.7), and 23,532 of these patients (35.8%) received general surgery. After propensity score matching, 14,179 patients (3906 patients from the sugammadex group and 10,273 patients from the neostigmine group) were included in the final analysis. Cox regression analysis in the propensity score-matched cohort showed that the risk of 90-day mortality was 40% lower in the sugammadex group than in the neostigmine group (hazard ratio: 0.60, 95% confidence interval: 0.37, 0.98; P = 0.042). These results were similar in the multivariable Cox regression analysis of the entire cohort (hazard ratio: 0.62, 95% confidence interval: 0.39, 0.96; P = 0.036). CONCLUSIONS: This retrospective cohort study suggested that reversing rocuronium with sugammadex might be associated with lower 90-day mortality after non-cardiac surgery compared to neostigmine. However, since this study did not evaluate quantitative neuromuscular function in the postoperative period due to its retrospective design, the results should be interpreted carefully. Future prospective studies with quantitative neuromuscular monitoring in the postoperative period should be performed to confirm these results.

5.
Am J Hypertens ; 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31956912

RESUMO

BACKGROUND: This study aimed to determine whether use of preoperative antihypertensive medication is associated with postoperative 90-day mortality in the hypertensive adult population that underwent elective non-cardiac surgery. METHODS: In this retrospective cohort study, medical records of preoperative hypertensive patients who underwent non-cardiac surgery at a single tertiary academic hospital from 2012 to 2018 were reviewed. Among the hypertensive patients, those prescribed to take antihypertensive medication continuously for more than 1 month before admission were defined as the HTN MED group; others were defined as the non-HTN MED group. Multiple imputation, propensity score (PS) matching, and logistic regression analysis were used for statistical analysis. RESULTS: Overall, 35,589 preoperative hypertensive adult patients (HTN MED group: 26,154 patients, non-HTN MED group: 9,435 patients) were included in the analysis. After PS matching, each group comprised 6,205 patients; thus, 12,410 patients were included in the final analysis. The odds for 90-day mortality of the HTN MED group in the PS-matched cohort were 41% lower (odds ratio: 0.59, 95% confidence interval: 0.41 to 0.85; P = 0.005) than those of the non-HTN MED group. Comparable results were obtained in the multivariable logistic regression analysis of the entire cohort (odds ratio: 0.54, 95% confidence interval: 0.41 to 0.72; P < 0.001). CONCLUSIONS: This study showed that the use of preoperative antihypertensive medication was associated with lower 90-day mortality among hypertensive patients who underwent non-cardiac surgery. Therefore, preoperative screening and treatment with appropriate antihypertensive medication are important for hypertensive patients.

6.
Sci Rep ; 10(1): 11, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31913310

RESUMO

This retrospective cohort study investigated the association between in-hospital survival and two-dimensional (2D) echocardiography within 24 hours after the return of spontaneous circulation (ROSC) in patients who underwent in-hospital cardiopulmonary resuscitation (ICPR) after in-hospital cardiopulmonary arrest (IHCA). The 2D-echo and non-2D-echo groups comprised eligible patients who underwent transthoracic 2D echocardiography performed by the cardiology team within 24 hours after ROSC and those who did not, respectively. After propensity score (PS) matching, 142 and 284 patients in the 2D-echo and non-2D-echo groups, respectively, were included. A logistic regression analysis showed that the likelihood of in-hospital survival was 2.35-fold higher in the 2D-echo group than in the non-2D-echo group (P < 0.001). Regarding IHCA aetiology, in-hospital survival after cardiac arrest of a cardiac cause was 2.51-fold more likely in the 2D-echo group than in the non-2D-echo group (P < 0.001), with no significant inter-group difference in survival after cardiac arrest of a non-cardiac cause (P = 0.120). In this study, 2D echocardiography performed within 24 hours after ROSC was associated with better in-hospital survival outcomes for patients who underwent ICPR for IHCA with a cardiac aetiology. Thus, 2D echocardiography may be performed within 24 hours after ROSC in patients experiencing IHCA to enable better treatment.

7.
Cancer Prev Res (Phila) ; 13(2): 195-202, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31699707

RESUMO

Metformin is known to have an antitumor effect; however, its effects in the prevention of cancer remain controversial. This study aimed to investigate the association of metformin therapy with the development of cancer. A population-based cohort study was conducted among adult patients with diabetes in 2010 using sample cohort data from the National Health Insurance Service. Metformin users were defined as those who had been prescribed repeated oral metformin administration over a period of ≥90 days. The primary endpoint of this study was the new development of cancer from January 1, 2011, to December 31, 2015. A total of 66,627 adult patients with diabetes were included in the final analysis; 29,974 were metformin users and 36,653 were controls. In the time-dependent Cox regression model, after multivariable adjustment, the risk for the development of cancer among metformin users was not significantly different from that among controls (HR = 0.96; 95% confidence interval, 0.89-1.03; P = 0.250). In the sensitivity analysis, neither low daily dosage (≤1 g/day, P = 0.301) nor high daily dosage (>1 g/day, P = 0.497) of metformin was significantly associated with the development of cancer between 2011 and 2015. We found no association between metformin therapy and the risk of cancer among patients with diabetes, even in the high daily dosage groups of metformin (>1 g/day). However, there might be residual confounders or bias; thus, further prospective, large population-based cohort studies are needed to confirm these findings. IMPACT: This population-based cohort study suggested a lack of association between metformin therapy and the risk of cancer among patients with diabetes. Therefore, the relationship between metformin therapy and the risk of cancer is still controversial.

8.
J Occup Environ Med ; 62(2): 93-97, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31651597

RESUMO

OBJECTIVE: We investigated the association between preadmission exposure to air pollutants and 90-day mortality in critically ill patients. METHODS: This retrospective cohort study analyzed the medical records of adult patients (more than or equal to 18 years) admitted to the intensive care unit of a tertiary academic hospital from 2015 to 2016. RESULTS: Four air pollutants were not significantly associated with 90-day mortality and pulmonary disease-related 90-day mortality (P > 0.05). In patients with preadmission chronic obstructive lung disease (COPD), a 1 ppm increase in ozone (O3) and carbon monoxide (CO) was associated with a 1.04-fold and 5.99-fold increase in pulmonary disease-related 90-day mortality, respectively. CONCLUSIONS: Preadmission exposure to air pollution was not associated with 90-day mortality in critically ill patients. However, a higher concentration of CO and O3 was associated with an increase in pulmonary disease-related 90-day mortality in patients with preadmission COPD.

9.
Eur J Anaesthesiol ; 37(1): 31-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31724965

RESUMO

BACKGROUND: There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients. OBJECTIVE: To investigate the association between peri-operative lactate level and 90-day mortality in patients admtted to the surgical ICU. DESIGN: Retrospective cohort study. SETTING: ICUs in single tertiary academic hospital. PATIENTS: Adult patients postoperatively admitted to the ICU between January 2012 and December 2017. INTERVENTION: None. MAIN OUTCOME MEASURES: Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used. RESULTS: Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1 mmol l, 90-day mortality increased by 15% [hazard ratio: 1.15; 95% confidence interval (CI) 1.11 to 1.19; P < 0.001] and 14% (hazard ratio: 1.14; 95% CI 1.11 to 1.18; P < 0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality (P = 0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95% CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95% CI 0.56 to 0.60) in the receiver operating characteristic analysis. CONCLUSION: In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.

10.
Ann Transl Med ; 7(20): 520, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31807502

RESUMO

Background: Physiological instability at discharge from intensive care units (ICU) is known to increase readmission rates among critically ill patients. However, associations between consciousness levels at discharge and readmission rates remain unclear. This study aimed to investigate the association between the Glasgow Coma Scale (GCS) score at discharge and unplanned ICU readmissions in surgical patients. Methods: This retrospective cohort study in a single tertiary academic hospital analyzed the electronic health records of adults aged 18 years or older, who were discharged from the ICU between January 2012 and December 2018. The primary endpoint was unplanned readmission within 48 hours after discharge. Multivariable logistic regression analysis was performed. Results: Among 9,512 patients, unplanned readmissions occurred in 161 (1.7%). At discharge, GCS and verbal response scores of ≤13 (vs. ≥14) were associated with 2.28-fold higher unplanned readmissions within 48 hours [odds ratio (OR): 2.35, 95% confidence interval (CI): 1.51-3.65, P<0.001]. Sensitivity analysis showed that verbal response scores of ≤4 (vs. 5) at ICU discharge were associated with 2.21-fold higher unplanned readmissions within 48 hours (OR: 2.21, 95% CI: 1.49-3.29, P<0.001), whereas eye or motor responses at time of ICU discharge were not significantly associated with unplanned readmissions (P>0.05). Conclusions: In this surgical ICU population cohort, GCS scores at ICU discharge were significantly associated with unplanned readmissions within 48 hours. This association was stronger with GCS scores of ≤13 and with verbal response scores of ≤4 at time of discharge. These findings suggest that surgical ICU patients with GCS scores of ≤13 or verbal response scores of ≤4 should be monitored carefully for discharge in order to avoid unplanned ICU readmissions.

11.
Ann Surg ; 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31850989

RESUMO

OBJECTIVE: The aim of this study was to investigate the association between preadmission statin use and 90-day mortality after planned elective noncardiac surgery in adult patients. SUMMARY BACKGROUND DATA: Statin therapy is known to have pleiotropic effects, which improve the outcomes of various diseases. However, the effect of perioperative statin therapy on postoperative mortality remains controversial. METHODS: This retrospective cohort study analyzed the medical records of adult patients who were admitted to a single tertiary academic hospital for elective noncardiac surgery between January 2012 and December 2018. The primary endpoint was 90-day mortality, which was defined as any mortality within 90 days after surgery. The secondary endpoint was overall survival. RESULTS: After propensity score matching, a total of 33,514 patients (16,757 patients in each group) were included in the analysis. The logistic regression analysis of the propensity score-matched cohort indicated that the odds ratio (OR) of 90-day mortality in the statin group was 26% lower than that of the nonstatin group [OR: 0.74; 95% confidence interval (CI): 0.59 to 0.92; P = 0.009]. The sensitivity analysis indicated that the high-dose intensity statin group had a 61% lower 90-day mortality rate than the nonstatin group (OR: 0.39; 95% CI: 0.18-0.84; P = 0.016). The overall survival time was significantly longer in the statin group than in the nonstatin group after propensity score matching (P < 0.001 by log-rank test). CONCLUSIONS: Preoperative statin use was associated with lower 90-day mortality and longer overall survival for adult patients who underwent elective noncardiac surgery. This association was more evident for high-intensity statin users.

12.
Acute Crit Care ; 34(1): 53-59, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31723905

RESUMO

Background: Postoperative body temperature is closely associated with prognosis although there is limited research regarding this association at Postoperative intensive care unit (ICU) admission. Furthermore, no studies have used digital axillary thermometers to measure Postoperative body temperature. This study investigated the association between mortality and Postoperative temperature measured using a digital axillary thermometer within 10 minutes after ICU admission. Methods: This retrospective observational study evaluated data from adult patients admitted to an ICU after elective or emergency surgery. The primary outcome was 1-year mortality after ICU admission. Multivariable logistic regression analysis with restricted cubic splines was used to evaluate the association between temperature and outcomes. Results: We evaluated data from 5,868 patients admitted between January 1, 2013 and May 31, 2016, including 5,311 patients (90.5%) who underwent noncardiovascular surgery and 557 patients (9.5%) who underwent cardiovascular surgery. Deviation from the median temperature (36.6℃) was associated with increases in 1-year mortality (≤ 36.6℃: linear coefficient, -0.531; P<0.001 and ≥36.6℃: spline coefficient, 0.756; P<0.001). Similar statistically significant results were observed in the noncardiovascular surgery group, but not in the cardiovascular surgery group. Conclusions: An increase or decrease in body temperature (vs. 36.6℃) measured using digital axillary thermometers within 10 minutes of Postoperative ICU admission was associated with increased 1-year mortality. However, no significant association was observed after cardiovascular surgery. These results suggest that Postoperative temperature is associated with longterm mortality in patients admitted to the surgical ICU in the Postoperative period.

13.
Anesth Analg ; 129(6): 1494-1501, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31743168

RESUMO

BACKGROUND: Postoperative hyperchloremia is known to be related to increases in mortality and morbidity after surgery. However, the relationship between preoperative hyperchloremia and hypochloremia and postoperative mortality and morbidity is not well established. Our aim was to evaluate the relationship between preoperative hyperchloremia or hypochloremia, as assessed using preoperative serum chloride tests, and 90-day mortality and morbidity after noncardiac surgery. METHODS: In this retrospective cohort study, we reviewed the medical records of patients >20 years of age who underwent noncardiac surgery between January 2010 and December 2016. Patients were categorized into one of the following groups on the basis of the results of serum chloride testing performed within 1 month before surgery: normochloremia, 97-110 mmol·L; hyperchloremia, >110 mmol·L; and hypochloremia, <97 mmol·L. The primary end point of this study was the difference in postoperative 90-day mortality among the preoperative serum chloride groups. The secondary end point was the difference in postoperative acute kidney injury incidence among the preoperative serum chloride groups. RESULTS: A total of 106,505 patients were included in the final analysis (2147 were allocated to the preoperative hypochloremia group and 617 to the hyperchloremia group). Multivariable Cox regression analysis revealed significantly increased 90-day mortality in the hypochloremia (hazard ratio, 1.46; 95% CI, 1.16-1.84; P = .001) and hyperchloremia (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .013) groups when compared with the normochloremia group. In addition, multivariable logistic regression analysis revealed a 1.83-fold increased odds of acute kidney injury in the preoperative hypochloremia group when compared with the normochloremia group (odds ratio, 1.83; 95% CI, 1.53-2.19; P < .001). CONCLUSIONS: Preoperative hypochloremia and hyperchloremia were related to increased 90-day mortality after noncardiac surgery. In addition, preoperative hypochloremia was related to an increased risk for postoperative acute kidney injury.

14.
J Anesth ; 33(6): 707, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31599356

RESUMO

In the original publication of the article, under the abstract, the last sentence of results was published incorrectly. The correct sentence should be as below.

15.
Yonsei Med J ; 60(10): 976-983, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31538433

RESUMO

PURPOSE: The objective of this study was to investigate whether financial coverage by the national insurance system for patients with lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge. MATERIALS AND METHODS: This study, conducted in a single tertiary hospital, used a retrospective cohort design to investigate discharged ICU survivors between January 2012 and December 2016. ICU survivors were classified into two groups according to the National Health Insurance (NHI) system in Korea: medical aid program (MAP) group, including people who have difficulty paying their insurance premium or receive medical aid from the government due to a poor economic status; and NHI group consisting of people who receive government subsidy for approximately 2/3 of their medical expenses. RESULTS: After propensity score (PS) matching, a total of 2495 ICU survivors (1859 in NHI group and 636 in MAP group) were included in the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.31-fold higher in MAP group than in NHI group (hazard ratio: 1.31, 95% confidence interval, 1.06 to 1.61; p=0.012). According to Kaplan-Meir estimation, MAP group also showed significantly poorer survival probability than NHI group after PS matching (p=0.011). CONCLUSION: This study showed that 1-year mortality was higher in ICU survivors with low economic status, even if financial coverage was provided by the government. Our result suggests the necessity of a more nuanced and multifaceted approach to policy for ICU survivors with low economic status.


Assuntos
Custos Hospitalares , Unidades de Terapia Intensiva/economia , Sobreviventes , Idoso , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pontuação de Propensão , Modelos de Riscos Proporcionais , República da Coreia , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
16.
Br J Anaesth ; 123(5): 655-663, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31558315

RESUMO

BACKGROUND: The Korean National Health Insurance Service (NHIS) was developed to provide population data for medical research. The aim of this study was to estimate trends in prescription opioid use in South Korea, and to determine the association between chronic opioid use and 5-yr mortality in cancer and non-cancer patients. METHODS: A population-based cohort study was conducted amongst the South Korean adult population using data from the NHIS. Those prescribed a continuous supply of opioids for ≥90 days were defined as chronic opioid users. Multivariable Cox regression analysis was used to assess the association between chronic opioid use and 5-yr mortality. RESULTS: The proportion of chronic weak opioid users increased from 1.03% in 2002 to 9.62% in 2015. The proportion of chronic strong opioid users increased from 0.04% in 2002 to 0.24% in 2015. In the 2010 cohort (n=822 214), compared with non-users, chronic weak opioid users had a significantly lower 5-yr mortality (hazard ratio [HR]: 0.93; 95% confidence interval [CI]: 0.89-0.96; P<0.001), and chronic strong opioid users had a significantly higher 5-yr mortality (HR: 1.45; 95% CI: 1.28-1.63; P<0.001). Similar results were observed in non-cancer patients, but chronic weak opioid users were not significantly associated with 5-yr mortality in cancer patients (P=0.063). CONCLUSIONS: In South Korea, chronic opioid use has increased since 2002. Chronic strong opioid use was associated with a higher 5-yr mortality, and chronic weak opioid use was associated with a slightly lower 5-yr mortality. However, the findings regarding chronic weak opioid users should be interpreted carefully because there might be residual confounders in this study. Further study is needed to confirm these retrospective findings.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/mortalidade , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/mortalidade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos
17.
J Anesth ; 33(6): 647-655, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31552504

RESUMO

PURPOSE: This study aimed to assess the impact of intensivist coverage on the incidence of acute kidney injury (AKI) and ventilator time among patients postoperatively admitted to the intensive care unit (ICU). METHODS: Adult patients postoperatively admitted to the ICU between January 2012 and December 2017 were retrospectively enrolled. The incidence of AKI within 72 h of surgery and the postoperative ventilator time were compared between the groups covered by intensivists and non-intensivists. RESULTS: After propensity score (PS) matching, 5650 patients were included in the final analysis (2825 patients in each group). The incidence rate of AKI was significantly higher in the non-intensivist coverage group than in the intensivist coverage group (22.7% vs. 20.2%; P = 0.023). Moreover, logistic regression analysis in the PS-matched cohort showed that the incidence of postoperative AKI in the non-intensivist coverage group increased by 16% compared to that in the intensivist coverage group (odds ratio 1.16, 95% confidence interval 1.02-1.32; P = 0.023). Additionally, the median time of ventilator use in the non-intensivist coverage group was significantly longer than that in the intensivist coverage group [7.8 (interquartile range, IQR 2.6-13.8) h vs. 5.3 (1.8-8.3) h; P < 0.001]. CONCLUSION: High-intensity intensivist coverage is associated with a lower risk of postoperative AKI and shorter postoperative ventilator times. These findings suggested that in addition to medical trainees, initial management of surgical ICU patients by intensivists may lower the risk of AKI and facilitate early weaning from mechanical ventilation.

18.
J Clin Neurosci ; 70: 173-177, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31420277

RESUMO

The serum lactate level is a useful predictor of mortality in critically ill patients. However, little is known about the association between the serum lactate level and mortality in patients admitted to neuro-intensive care units (NCUs). The present study aimed to investigate the association between the initial lactate level and 90-day mortality in NCU patients. This retrospective observational study was conducted by reviewing the medical records of adult (age ≥18 years) patients admitted to the NCU at a single tertiary care academic hospital during 2013-2017. The initial lactate level (mmol L-1) was defined as the serum lactate level measured within 6 h following NCU admission. The final analysis included 2737 patients, of whom 280 (10.2%) died within 90 days of NCU admission. In a receiver operating characteristic (ROC) analysis, the estimated area under the curve (AUC) for the initial lactate level in predicting overall 90-day mortality was 0.55 [95% confidence interval (CI): 0.52-0.59]. The corresponding values for neurologic and non-neurologic disease-related 90-day mortality were 0.76 (95% CI: 0.71-0.82) and 0.49 (95% CI: 0.45-0.53), respectively. In a multivariable Cox regression analysis, a 1-mmol L-1 increase in the initial lactate level was associated with 1.17- and 1.22-fold increases in overall and neurologic disease-related 90-day mortality, respectively, but not with non-neurological disease-related 90-day mortality (P = 0.422). Elevated lactate levels were related with an increase in overall 90-day mortality among NCU patients. This association was specifically attributed to neurologic disease-related 90-day mortality.


Assuntos
Estado Terminal/mortalidade , Ácido Láctico/sangue , Doenças do Sistema Nervoso/sangue , Doenças do Sistema Nervoso/mortalidade , Adulto , Idoso , Área Sob a Curva , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
19.
Cancer Control ; 26(1): 1073274819871326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31452400

RESUMO

Opioid use can induce immunosuppression; however, it is unclear whether opioid use increases infections in patients with advanced cancers. This study assessed the association between opioid use in the week before death and mortality among patients with advanced lung cancer having sepsis. Data on opioid usage in the week before death, general information, and clinical information of the patients were collected retrospectively. The primary outcome was the association between opioid use in the week before death and mortality after sepsis. The study included 980 patients who died of advanced lung cancer between January 2003 and June 2017 (sepsis related: 413, unrelated to sepsis: 567). The average morphine equivalent daily dose in the final week was higher in the sepsis group (313.5 ± 510.5 mg) than in the nonsepsis group (125.2 ± 246.9 mg, P < .001). A significant association was found between the average morphine equivalent daily dose in the final week and mortality due to sepsis (odds ratio: 1.02, 95% confidence interval: 1.01-1.02, P < .001). This was especially evident when the dose was increased by 10 mg in the final week. Furthermore, older age, male sex, and a lower body mass index were associated with an increased risk of mortality after developing sepsis. Opioid use in the week before death may be associated with mortality for patients with advanced lung cancer having sepsis.


Assuntos
Analgésicos Opioides/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Dor/tratamento farmacológico , Sepse/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Análise Multivariada , Dor/etiologia , Dor/mortalidade , Estudos Retrospectivos , Sepse/complicações , Sepse/mortalidade , Taxa de Sobrevida
20.
Medicine (Baltimore) ; 98(26): e16142, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261539

RESUMO

Use of sugammadex for neuromuscular block reversal is associated with fewer postoperative complications than neostigmine; however, the effects on postoperative pain outcomes are largely unknown. In this retrospective study, we investigated the relationship between neuromuscular reversal agents and postoperative pain-related outcomes following laparoscopic gastric cancer surgery.We reviewed the electronic health records of patients who underwent laparoscopic gastric cancer surgery between January 2010 and June 2017. Patients were divided into a sugammadex group and a neostigmine group, according to the neuromuscular block reversal agent used. We compared the pain outcomes in the first 3 days postoperatively (POD 0-3), length of hospital stay, and postoperative complications (Clavien-Dindo grade ≥II).During the study period, 3056 patients received sugammadex (n = 901) or neostigmine (n = 2155) for neuromuscular reversal. After propensity score matching, 1478 patients (739 in each group) were included in regression analysis. In linear regression analysis, intravenous morphine equivalent consumption (mg) during POD 0 to 3 was higher in the sugammadex group than in the neostigmine group [coefficient 103.41, 95% confidence interval (CI): 77.45-129.37; P <.001]. However, hospital stay was shorter (coefficient: -0.60, 95% CI -1.12 to -0.08; P = .025) and postoperative complication rate was lower (odds ratio: 0.20, 95% CI 0.07-0.58; P = .003) in the sugammadex group.In this retrospective study, patients undergoing laparoscopic gastric cancer surgery who received sugammadex for neuromuscular block reversal exhibited greater postoperative analgesic requirements than those who received neostigmine but had a shorter hospital stay and a lower postoperative complication rate. A randomized and blinded study should be conducted in the future to confirm the findings of the present study.


Assuntos
Analgésicos/uso terapêutico , Laparoscopia , Neostigmina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Sugammadex/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Bloqueio Neuromuscular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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