Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality
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Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG) surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. We used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery. Among 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients) for patients treated within the recommended time and 1.5% (70 among 4641) for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96). There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11). We found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis.Cite
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Background and purpose — Using patient-reported health-related quality of life (HRQoL), approximately 10% of patients report some degree of dissatisfaction after a total hip arthroplasty (THA). The preoperative comorbidity burden may play a role in predicting which patients may have limited benefit from a THA. Therefore, we examined whether gain in HRQoL measured with the EuroQol-5D (EQ-5D) at 3 and 12 months of follow-up depended on the comorbidity burden in THA patients Patients and methods — 1,582 THA patients treated at the Regional Hospital West Jutland from 2008 to 2013 were included. The comorbidity burden was collected from an administrative database and assessed with the Charlson Comorbidity Index (CCI). The CCI was divided into 3 levels: no comorbidity burden, low, and high comorbidity burden. HRQoL was measured using the EQ-5D preoperatively and at 3 and 12 months' follow-up. Association between low and high comorbidity burden compared with no comorbidity burden and gain in HRQoL was analyzed with multiple linear regression. Results — All patients, regardless of comorbidity burden, gained significantly in HRQoL. A positive association between comorbidity burden and gain in HRQoL was found at 3-month follow-up for THA patients with a high comorbidity burden (coeff: 0.09 (95% CI 0.02 – 0.16)) compared with patients with no comorbidity burden. Interpretation — A comorbidity burden prior to THA does not preclude a gain in HRQoL up to 1 year after THA.
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There are several different definitions of the combination of multiple nosology within one organism: comorbidity, multimorbidity, syntropy, and dystropy, etc. Comorbidity is an important component of pathophysiological processes, which has a significant impact on the course and outcome of cardiac diseases in patients. Therefore, in recent decades, researchers have been actively engaged in the problem of assessing the degree of contribution of comorbidity to the overall state of the body. For this purpose, a number of scales and indices of comorbidity have been developed, which allow estimating the burden of comorbidity on the underlying disease within certain groups of diseases. Consideration of comorbidity in routine clinical practice allows to increase reliable prognostic assumptions and correctly build a therapeutic strategy. As a result, it improves patients’ quality of life, allows them to achieve favorable outcomes, and most effectively prevents complications in patients with comorbidity. The assessment of comorbidity in cardiological, endocrinological, oncological, and neurological pathologies is particularly important, since they have the most general negative effect on the entire patient’s body.
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在治疗的选择和老病人的幸存上识别 comorbidity 的影响的目的(≥ 70 年) 与先进非小的房间肺癌症(NSCLC ) 。方法临床的特征和 177 个老病人，有好表演地位，的治疗的选择 PS ≤ 1 ) 回顾地在肿瘤学部门被分析，上海肺的医院，在到 2005 年 12 月的 2005 年 1 月之间。幸存数据仅仅在收到了化疗的那些被分析。所有病人被 comorbidity 的数字作为没有(0 ) 成层，温和(1 2 ) 并且严重(≥ 3 ) 组。结果病人，收到了化疗，的比例温和、严重的 comorbidity 是显著地不同的(79.3%，76.2%和57.4%， P = 0.038 )，并且也有关于在三个组之中的辩解的放射疗法率显著地不同(21.7%，11.7%和37.0%， P = 0.014 )。中部的幸存和 1 年的幸存在没有评价，温和、严重的 comorbidity 组，是 13.6 对 10.2 对 7.6 个月并且 53.5% 对 41.3% 对 20.8% 分别地(木头等级， P = 0.071 ) 。在 univariate 并且多，变量考克斯为分析建模，仅仅严重的 comorbidity 是有 NSCLC 的老病人的幸存的一个独立危险因素。相对比率(RR， 95% CI ) ：(2.09， 1.06 4.15 ) ， P = 0.034。结论 Comorbidity 可以稍微与先进 NSCLC 影响老病人的治疗的选择，但是仅仅严重的 comorbidity 是幸存的一个独立预示的因素。
Univariate analysis
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Comorbidity may be an important reason for head and neck surgeons to treat elderly patients less intensively. This article provides an overview of the influence of age and comorbidity on choice of therapy, postoperative complications, and survival.Several retrospective studies show that elderly patients can undergo surgery if they do not have severe comorbid disorders. Severe comorbidity influences the rate of postoperative complications, and the higher complication rate in older patients reported in some studies is probably due to a higher level of comorbidity. Comorbidity also affects the survival of cancer patients, but several studies have failed to detect a relation between age and survival after correction for comorbidity. Thus, although severe comorbidity may influence the choice of treatment, patient age as such should not be a reason to exclude patients from intensive therapy.If severe comorbidity is not present, elderly patients should receive standard treatment for head and neck cancer. Treatment choice should be based on medical findings and patient preference, not on chronologic age.
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The presence of cardiovascular comorbidity in non-small-cell lung cancer (NSCLC) patients increases with age. Therefore, the influence of cardiovascular comorbidity in NSCLC patients on their short- or long-term prognosis remains controversial. This study evaluated the possible risk factors related to the short-term and long-term survivals in NSCLC patients with cardiovascular comorbidity.One thousand one hundred and sixty-two consecutive patients with NSCLC who had undergone a surgical resection between 1984 and 2010 were enrolled in this study. A total of 360 (31%) patients with cardiovascular comorbidities were analysed to identify the risk factors for postoperative complications and prognostic factors.The patients with cardiovascular comorbidity included 301 with hypertension, 28 with coronary artery disease, 35 with peripheral vascular disease, 23 with arrhythmia and 11 with abdominal aortic aneurysm. Eighty-three patients exhibited more than one type of comorbidity. The postoperative cardiovascular morbidity rates were 3.6% in the cardiovascular comorbidity patients and 3.3% among patients without cardiovascular comorbidity (P = 0.73). No correlation was observed between preoperative cardiovascular comorbidity and postoperative pulmonary complications (P = 0.52). The operative mortality rates were 1.0% for the cardiovascular comorbidity patients and 0.8% for the other patients (P = 0.51). No difference in the postoperative outcomes was observed between the patients with and without cardiovascular comorbidity. The 5-year survival rates were 62.5% in comparison with 65.4% among patients without cardiovascular comorbidity (P = 0.48).Patients with cardiovascular comorbidity were not found to be at increased risk of mortality and morbidity following surgery for NSCLC. In addition, cardiovascular comorbidity did not influence the long-term outcomes of patients after a pulmonary resection for NSCLC.
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