Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Resultados 1 - 4 de 4
Filtrar
1.
BMC Anesthesiol ; 22(1): 58, 2022 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-35240985

RESUMEN

BACKGROUND: Standardized risk assessment tools can be used to identify patients at higher risk for postoperative complications and death. In this study, we validate the PreOperative Score to predict Post-Operative Mortality (POSPOM) for in-hospital mortality in a large cohort of non-cardiac surgery patients. In addition, the performance of POSPOM to predict postoperative complications was studied. METHODS: Data from the control cohort of the TRACE (routine posTsuRgical Anesthesia visit to improve patient outComE) study was analysed. POSPOM scores for each patient were calculated post-hoc. Observed in-hospital mortality was compared with predicted mortality according to POSPOM. Discrimination was assessed by receiver operating characteristic curves with C-statistics for in-hospital mortality and postoperative complications. To describe the performance of POSPOM sensitivity, specificity, negative predictive values, and positive predictive values were calculated. For in-hospital mortality, calibration was assessed by a calibration plot. RESULTS: In 2490 patients, the observed in-hospital mortality was 0.5%, compared to 1.3% as predicted by POSPOM. 27.1% of patients had at least one postoperative complication of which 22.4% had a major complication. For in-hospital mortality, POSPOM showed strong discrimination with a C-statistic of 0.86 (95% CI, 0.78-0.93). For the prediction of complications, the discrimination was poor to fair depending on the severity of the complication. The calibration plot showed poor calibration of POSPOM with an overestimation of in-hospital mortality. CONCLUSION: Despite the strong discriminatory performance, POSPOM showed poor calibration with an overestimation of in-hospital mortality. Performance of POSPOM for the prediction of any postoperative complication was poor but improved according to severity.


Asunto(s)
Complicaciones Posoperatorias , Mortalidad Hospitalaria , Humanos , Complicaciones Posoperatorias/diagnóstico , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo
2.
Platelets ; 22(2): 160-3, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21142407

RESUMEN

Monitoring the course of platelet function in HELLP (haemolysis, elevated liver-enzymes and low platelets) syndrome is important for clinical decision-making. We present a primigravid woman developing HELLP syndrome at 29 weeks and 6 days. Platelet function was monitored by multiple electrode aggregometry (MEA), platelet function analyzer (PFA-100®), platelet count and mean platelet volume (MPV) over an 11-day period. MPV and PFA-100® seem better predictors for platelet function than platelet levels.


Asunto(s)
Plaquetas/metabolismo , Síndrome HELLP/diagnóstico , Adulto , Antihipertensivos/uso terapéutico , Plaquetas/citología , Femenino , Síndrome HELLP/sangre , Síndrome HELLP/tratamiento farmacológico , Humanos , Recuento de Plaquetas , Embarazo , Resultado del Tratamiento
3.
Anesthesiol Clin ; 37(4): 751-768, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31677689

RESUMEN

Adult patients with congenital heart disease are a complex population with a variety of pathophysiologic conditions based on the anatomy and type of surgery or intervention performed, usually during the first years of life. Nowadays, the majority of patients survive childhood and present for a number of noncardiac surgeries or interventions needing appropriate perioperative management. Heart failure is a major contributing factor to perioperative morbidity and mortality. In this review, we present an overview of the most common types of adult patients with congenital heart disease and actual knowledge on therapy and specific risks in this challenging patient population.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/cirugía , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/terapia , Adulto , Niño , Preescolar , Procedimiento de Fontan , Humanos , Lactante , Recién Nacido
4.
Trials ; 19(1): 586, 2018 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-30367680

RESUMEN

BACKGROUND: Perioperative complications occur in 30-40% of non-cardiac surgical patients and are the leading cause of early postoperative morbidity and mortality. Regular visits by trained health professionals may decrease the incidence of complications and mortality through earlier detection and adequate treatment of complications. Until now, no studies have been performed on the impact of routine postsurgical anesthesia visits on the incidence of postoperative complications and mortality. METHODS: TRACE is a prospective, multicenter, stepped-wedge cluster randomized interventional study in academic and peripheral hospitals in the Netherlands. All hospitals start simultaneously with a control phase in which standard care is provided. Sequentially, in a randomized order, hospitals cross over to the intervention phase in which patients at risk are routinely followed up by an anesthesia professional at postoperative days 1 and 3, aiming to detect and prevent or treat postoperative complications. We aim to include 5600 adult patients who are at high risk of developing complications. The primary outcome variable is 30-day postoperative mortality. Secondary outcomes include incidence of postoperative complications and postoperative quality of life up to one year following surgery. Statistical analyses will be performed to compare the control and intervention cohorts with multilevel linear and logistic regression models, adjusted for temporal trends and for clusters (hospitals). The time horizon of the economic (cost-effectiveness) evaluation will be 30 days and one year following surgery. DISCUSSION: TRACE is the first to study the effects of a routine postoperative visit by an anesthesia healthcare professional on mortality and cost-effectiveness of surgical patients. If the intervention proves to be beneficial for the patient and cost-effective, the stepped-wedge design ensures direct implementation in the participating hospitals. TRIAL REGISTRATION: Nederlands Trial Register/Netherlands Trial Registration, NTR5506 . Registered on 02 December 2015.


Asunto(s)
Anestesia/efectos adversos , Anestesiología/métodos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias , Derivación y Consulta , Procedimientos Quirúrgicos Operativos/efectos adversos , Adolescente , Adulto , Anestesia/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Países Bajos , Cuidados Posoperatorios/efectos adversos , Cuidados Posoperatorios/mortalidad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapia , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Factores de Riesgo , Procedimientos Quirúrgicos Operativos/mortalidad , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
SELECCIÓN DE REFERENCIAS
Detalles de la búsqueda