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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Our experience with 101 consecutive T.H.A.'s in 91 patients was examined in an attempt to identify preoperative risk factors for postoperative medical complications, especially pulmonary embolism and thrombophlebitis. Six per cent of patients developed postoperative clinical thrombophlebitis, and 8% a pulmonary embolism. Advancing age and previous venous thrombosis served as predictors for pulmonary embolism and thrombophlebitis, respectively (p less than 0.01), but obesity, venous varicosities, diabetes mellitus, cigarette smoking, previous pulmonary embolism, and length of surgery did not, for either. Fifty per cent of the patients with preoperative abnormal kidney function developed some form of medical complication postoperatively, a significant increase in risk (p less than 0.05) over patients with normal kidney function. We were unable to identify an increase in postoperative atelectasis or pneumonia associated with smoking or obesity in these patients. No consistent decrease in post-operative medical morbidity could be assigned to preoperative medical consultations, suggesting that we have not yet identified all significant risk factors. A thorough preoperative preparation and improvement in intra- and postoperative techniques and management may account for differences found in this study from traditionally held risk factors.
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PMID:Risk factor assessment in 101 total hip arthroplasties: a medical perspective. 47 24

The method and results of applying ultrasonic aerosols in 485 patients, operated upon on abdominal organs, are presented. Ultrasonic aerosols were included in the complex of prophylactic and therapeutic measures in the postoperative period. Prophylactic measures were started immediately after patient's being returned from the operating room. Special attention was given to patients in whom ventilatory disturbances developed during anesthesia, to patients with obesity, chronic bronchitis, emphysema, pneumosclerosis and also those, who negated the rationality of prophylactic measures. The use of finely dispersed aerosols after the method suggested by the authors allowed a 6 times reduction in the incidence of pulmonary complications and more than twice shortening of the postoperative pneumonia course.
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PMID:[Prevention and treatment of postoperative broncho-pulmonary complications with ultrasonic aerosols]. 96 Apr 62

In a retrospective computerized study of 451 Austin Moore arthroplasties (211 for acute hip fractures and 240 for hip reconstruction), the operative and general complications were correlated with the historical, preoperative, operative, and early and late postoperative factors usually thought to influence the results. Wound complications were significantly associated with diabetes and fracture, obesity and fracture, and procedures lasting two hours or more. General complications showing significant associations were: death or pneumonia with fractures, phlebitis with obesity, and myocardial infarction with fracture. Factors not significantly associated with complications included age, previous hip surgery, time of day of the operation, surgical approach, wound irrigation, use of drains, postoperative anticoagulation, and reaming of the acetabulum.
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PMID:Complications of Austin Moore arthroplasty. Their incidence and relationship to potential predisposing factors. 107 27

Sixteen risk factors for nosocomial pneumonia were prospectively studied in 582 intubated patients in a surgical intensive care unit (ICU) to identify patients at particularly high risk. Overall, pneumonias developed in 94 of the patients (16%). Significant risk factors for pneumonia were mechanical ventilation for more than 72 h, impaired consciousness or co-operation, specific therapeutic interventions as a marker of severe underlying diseases (dopamine/dobutamine greater than or equal to 5 micrograms/kg.min, barbiturate therapy for treatment of elevated intracranial pressure, continuous i.v. antiarrhythmic or antihypertensive drugs), and pre-existing pulmonary abnormalities (P less than 0.001). The acquisition of postoperative pneumonia was further associated with male sex, ASA class IV and a history of smoking, but statistical significance was lost after stepwise logistic regression. Longer operative procedures, thoracic or upper abdominal surgery, longer preoperative hospital stay, low serum albumin concentration on admission, prior antibiotics, old age, obesity, low weight, malignant disease, and steroid treatment did not influence the incidence of pneumonia. In this study we were able to identify a subpopulation of intensive care patients at particularly high risk for pneumonia.
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PMID:[Risk factors in nosocomial pneumonia in intensive care patients. A prospective study to identify high-risk patients]. 195 43

Case histories of 2582 patients requiring median sternotomy for coronary artery bypass grafting between January 1982 and August 1986 were retrospectively reviewed. Only saphenous vein grafts were used in 230 patients, one mammary artery graft was used in 1626 patients, and both mammary arteries were used in 726 patients. The relationship of potential risk factors and wound complication was evaluated. The overall incidence of wound complications was 0.81%-0.43% in the saphenous vein graft group, 0.49% in the single mammary group, and 1.65% in the bilateral mammary group. Graft type and a number of potential risk factors were analyzed in a logistic regression analysis to determine significant predictors of wound complications. The results indicated that pneumonia, obesity, reexploration, use of the intraaortic balloon pump, and diabetes were significant risk factors contributing to the probability of wound complications. Bilateral mammary grafting was significantly associated with the increased probability of a wound complication developing. Bilateral mammary grafting increased the chance of wound complication nearly five times that of saphenous vein grafting and three times that of single mammary grafting. Mammary artery grafts have been shown to achieve greater long-term patency than saphenous vein grafts, and their continued use is encouraged. However, the potential for increased wound problems should be considered along with other significant preoperative risk factors such as insulin-dependent diabetes, chronic pulmonary disease, and obesity.
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PMID:Wound complications after median sternotomy. Relationship to internal mammary grafting. 258 26

To assess the meaning of hospital-associated death rates, we studied whether mortality within 30 days of hospital admission (30-day mortality) is more informative than inpatient mortality and whether detailed assessment of additional discharge diagnoses helps in understanding death rates. We examined hospitalizations for elderly Medicare patients with principal diagnoses of stroke, bacterial pneumonia, myocardial infarction, and congestive heart failure; these conditions account for 30.8% of Medicare 30-day mortality. Average hospital stays for these conditions were 99.0% longer, and inpatient mortality was 25.0% higher in New York than in California, but 30-day mortality was 1.6% higher in California. We conclude that inpatient death rates depend on length-of-stay patterns and give a biased picture of mortality. Additional diagnoses such as shock and pneumonia were strongly associated with increased mortality, but Medicare data do not reveal which patients had these conditions at the time of admission. Recorded diagnoses of chronic diseases such as hypertension, diabetes mellitus, obesity, benign prostatic hypertrophy, and osteoarthritis were commonly associated with reduced risk of death; such reduced risk is not clinically plausible. Several lines of evidence suggest that chronic disorders are underreported for patients with life-threatening disorders. We recommend great caution in using discharge diagnoses of comorbid conditions to adjust hospital death rates for clinical differences in the patient populations.
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PMID:Assessing hospital-associated deaths from discharge data. The role of length of stay and comorbidities. 270 88

A defined general population of 159,200 male and female native Swedes born in the period of 1911-1940, from an urban catchment area of the then only general hospital, was followed over a decade (1970-1979) with regard to inpatient hospitalization for all kinds of diagnoses. Psoriasis cases (n = 372) are significantly (p less than 0.001) associated with a spectrum of diseases: male as well as female psoriatics seem to show excess rates of viral infections, alcoholism, hypertension, pneumonia, liver cirrhosis, urticaria, and rheumatoid arthritis. Psoriasis in males only seem to be associated with iritis and ankylosing spondylitis, whereas psoriasis in females only is associated with lung cancer, diabetes, obesity, myocardial infarction and asthma.
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PMID:Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. 308 49

To determine predictors of postoperative morbidity in elective cholecystectomy patients, the authors examined prospectively the consequences of age, sex, active and past smoking, respiratory history, obesity, type of surgical incision, and preoperative pulmonary function, upon the incidence of postoperative pulmonary complications and length of hospitalization. They identified 31 (14.8%) complications in 209 patients; 21 had atelectasis, 8 purulent bronchitis, and 2 pneumonia. These patients averaged 1.5 days longer in the hospital (p less than 0.001 by analysis of variance) than control patients. Abnormal spirometry (MEFV) and the single-breath nitrogen test (SBN2) were significant predictors of postoperative pulmonary complications (p less than 0.001 by discriminant analysis method). Active smoking and history of respiratory disease were associated with abnormal small airway function (p less than 0.001 by chisquare test), but did not predict postoperative morbidity. By analysis of variance, only a reduction in preoperative FVC emerged as predictive of prolonged hospitalization (p less than 0.001). These results were used to determine if the selection of patients by preoperative pulmonary function testing permits more cost-effective administration of respiratory therapy (RT) services. Neither the MEFV nor SBN2 had sufficient specificity to enhance the cost effectiveness of postoperative RT.
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PMID:Can postoperative pulmonary complications after elective cholecystectomy be predicted? 312 67

In relation to antiasthmatic treatment of hospitalized patients with theophyllines, results concerning: a) a retrospective analysis of plasma levels observed over a 18-month period; b) a pharmacokinetic study and consequent determination of an efficient individual posology are reported. On the 194 serum drug tests (each comprehensive of the trough and peak concentrations) evaluated, 58 (30%) entered the retrospective study, after screening by predetermined criteria. 96 out of 194 (49%) tests were eliminated because of inappropriate sample collection or irrational dosage regimen. The theophylline blood levels, distinguished by drug formulation and posology, were spread over very large ranges (coefficient of variation up to 88%, mean of 55%), so that many concentrations were subtherapeutic or potentially toxic. The kinetic study, undergone by 22 patients, was carried out by administering and intravenous test-dose of aminophylline, followed by collection of blood samples at determined times. Elimination half-life, clearance and volume of distribution were then calculated by means of the plasma theophylline concentrations and subsequently an individual optimized dosage regimen (so as to keep the blood drug levels within the 8-16 mg.l-1 range) was determined. The considerable variability of elimination rate observed among patients (extreme values of half-life and clearance differ 10-fold) mainly account for the unforeseeability of plasma levels obtainable with a given posology. Even if the factors affecting the elimination rate of theophylline (i.e. cigarette smoking, obesity, congestive heart failure, chronic obstructive pulmonary disease, pneumonia) are taken into account, the blood concentrations are frequently unforeseeable. Therefore, the monitoring of plasma levels is necessary for every patient treated with theophyllines and a pharmacokinetic study is desirable in some cases.
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PMID:[Importance of the laboratory in optimizing anti-asthma therapy with theophylline]. 332 89

Pulmonary complications remain the most important cause of postoperative morbidity and mortality. The many advances of modern surgical care over the last 30 years have not appreciably altered the incidence of these complications. Many risk factors have been shown to contribute to this problem, but no studies have examined the impact of preoperative protein depletion on respiratory function and related this to the development of postoperative pulmonary complications. 80 patients (42 men, 38 women, median age of 64 years, with a range of 15-91 years) awaiting major elective gastrointestinal (G.I.) surgery were divided into two categories on the basis of a direct measurement of protein depletion: nonprotein-depleted patients (n = 41, mean protein loss, 2% +/- 1.7 SEM) and protein-depleted patients (n = 39, mean protein loss, 36% +/- 3.5 SEM). There was no significant difference between these two categories in regard to age, height, sex, surgical diagnosis, the presence of chronic lung disease, smoking, proportion of upper abdominal incisions, degree of obesity, the duration of anesthesia, and the use of prophylactic antibiotics and physiotherapy. There was a significant difference between these two categories of patients in regard to respiratory muscle strength (p less than .025), vital capacity (p less than .05), and peak expiratory flow rate (p less than .005). Pneumonia developed in a significantly higher proportion of protein-depleted patients with atelectasis (p less than .05), and their stay in the hospital after surgery was longer (p less than .05). These data show that protein depletion is associated with an impairment of respiratory function, and is in itself a significant risk factor in the development of postoperative pneumonia.
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PMID:Risk factors for postoperative pneumonia. The importance of protein depletion. 340 Oct 64


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