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Javad Parvizi - One of the best experts on this subject based on the ideXlab platform.
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in Hospital Mortality in patients with periprosthetic joint infection
Orthopaedic Proceedings, 2018Co-Authors: Alisina Shahi, Antonia F Chen, Mitchell G Maltenfort, Javad ParviziAbstract:Periprosthetic joint infection (PJI) is one of the most devastating complications of total joint arthroplasty (TJA). Only a few studies have investigated PJI's impact on the most worrisome of all endpoints, Mortality. The purpose of this study was to perform a large-scale study to determine the rates of PJI associated in-Hospital Mortality, and compare it to other surgical procedures.The Nationwide Inpatient Sample was queried from 2002 to 2010 to assess the risk of Mortality for patients undergoing revision for PJI or aseptic failures. Elixhauser comorbidity index and ICD-9 codes were used to obtain patients’ medical conditions and identify PJI. Multiple logistic-regression analyses were used to determine the associated variables with Mortality. In-Hospital Mortality was compared to the followings: coronary-artery bypass graft, mastectomy, prostatectomy, appendectomy, kidney transplant, carotid surgery, cholecystectomy, and coronary interventional procedures.PJI was associated with an increased risk (odd...
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in Hospital Mortality in patients with periprosthetic joint infection
Journal of Arthroplasty, 2017Co-Authors: Alisina Shahi, Antonia F Chen, Mitchell G Maltenfort, Javad ParviziAbstract:Abstract Background While periprosthetic joint infection (PJI) has a huge impact on patient function and health, only a few studies have investigated its impact on Mortality. The purpose of this large-scale study was to (1) determine the rate and trends of in-Hospital Mortality for PJI and (2) compare the in-Hospital Mortality rate of patients with PJI and those undergoing revision arthroplasty for aseptic failure and patients undergoing other nonorthopedic major surgical procedures. Methods Data from the Nationwide Inpatient Sample from 2002 to 2010 were analyzed to determine the risk of in-Hospital Mortality for PJI patients compared with aseptic revision arthroplasty. The Elixhauser comorbidity index was used to obtain patient comorbidities. Multiple logistic regression analyses were used to examine whether PJI and other patient-related factors were associated with Mortality. Results PJI was associated with an increased risk (odds ratio, 2.05; P Conclusion Patients undergoing treatment for PJI have a 2-fold increase in in-Hospital Mortality for each surgical admission compared to aseptic revisions. Considering that PJI cases often have multiple admissions and that this analysis is by surgical admission, the risk of Mortality will accumulate for every additional surgery. Surgeons should be cognizant of the potentially fatal outcome of PJI and the importance of infection control to reduce the risk of Mortality.
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in Hospital Mortality in patients with periprosthetic joint infection
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Alisina Shahi, Antonia F Chen, Mitchell G Maltenfort, Javad ParviziAbstract:Periprosthetic joint infection (PJI) is one of the most devastating complications of total joint arthroplasty (TJA). Only a few studies have investigated PJI9s impact on the most worrisome of all endpoints, Mortality. The purpose of this study was to perform a large-scale study to determine the rates of PJI associated in-Hospital Mortality, and compare it to other surgical procedures. The Nationwide Inpatient Sample was queried from 2002 to 2010 to assess the risk of Mortality for patients undergoing revision for PJI or aseptic failures. Elixhauser comorbidity index and ICD-9 codes were used to obtain patients’ medical conditions and identify PJI. Multiple logistic-regression analyses were used to determine the associated variables with Mortality. In-Hospital Mortality was compared to the followings: coronary-artery bypass graft, mastectomy, prostatectomy, appendectomy, kidney transplant, carotid surgery, cholecystectomy, and coronary interventional procedures. PJI was associated with an increased risk (odds ratio 2.04) of in-Hospital Mortality (0.77%) compared to aseptic revisions (0.38%). The in-Hospital Mortality of revision THAs done for PJI (1.38%, 95%CI, 1.12–1.64%) was comparable to or higher than interventional coronary procedure (1.22%, 95%CI, 1.20–1.24%), cholecystectomy (1.13%, 95%CI, 1.11–1.15%), kidney transplantation (0.70%, 95%CI, 0.61%–0.79%) and carotid surgery (0.89%, 95%CI, 0.86%–0.93%) (Figure 1). The following comorbidities were independent risk factors for in-Hospital Mortality after TJA: liver disease, metastatic disease, fluid and electrolyte disorders, coagulopathy, weight loss and malnutrition, congestive heart failure, pulmonary circulation disorder, renal failure, and peripheral vascular disease. PJI is associated with a two-fold increase in Mortality and have Mortality rates comparable to kidney transplantation and carotid surgery. Considering the fact that patients with PJI often require multiple surgical procedures, the rate of actual in-Hospital Mortality for patients with PJI may be considerably higher. Surgeons should be cognizant of the potentially fatal outcome of PJI and must emphasize the importance of infection control to reduce the risk of Mortality.
Marin H. Kollef - One of the best experts on this subject based on the ideXlab platform.
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the determinants of Hospital Mortality among patients with septic shock receiving appropriate initial antibiotic treatment
Critical Care Medicine, 2012Co-Authors: Andrew Labelle, Scott T. Micek, Richard M Reichley, Paul Juang, Justin Hoffmann, Alex Hoban, Nicholas Hampton, Marin H. KollefAbstract:Objective:To identify the determinants of Hospital Mortality among patients with septic shock receiving appropriate initial antibiotic treatment.Design:A retrospective cohort study of Hospitalized patients with blood culture positive septic shock (January 2002–December 2007).Setting:Barnes-Jewish Ho
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predictors of in Hospital Mortality for bloodstream infections caused by enterobacter species or citrobacter freundii
Pharmacotherapy, 2007Co-Authors: Eli N Deal, Scott T. Micek, David J Ritchie, Richard M Reichley, Michael W Dunne, Marin H. KollefAbstract:Study Objective. To identify predictors of in-Hospital Mortality among patients with bacteremia caused by Enterobacter cloacae, Enterobacter aerogenes, or Citrobacter freundii. Design. Retrospective cohort study. Setting. 1300-bed tertiary academic medical center. Patients. One hundred twenty-four patients who had bloodstream infections caused by E. cloacae (3), E. aerogenes (71), or C. freundii (50) between 1998 and 2004. Measurements and Main Results. Data from patients with bloodstream infections caused by Enterobacter sp or C. freundii were retrospectively segregated according to Hospital survival (98 survivors, 26 nonsurvivors). Multiple patient characteristics and processes of care were evaluated to identify factors contributing to in-Hospital Mortality. Multiple logistic regression was performed based on univariate comparisons to determine independent risk factors for in-Hospital Mortality. Among the 124 cases of bacteremia, the crude in-Hospital Mortality rate was 21% (26 cases). Univariate analysis revealed that survivors were more likely to receive an aminoglycoside as part of their empiric antimicrobial regimen (40% [39/98]) compared with nonsurvivors (19% [5/26], p=0.05). Other factors related to antimicrobial therapy including choice and number of agents used did not differ between survivors and nonsurvivors (p>0.05). Vasopressor use (31% [30/98] vs 62% [16/26]), care in an intensive care unit (19% [19/98] vs 54% [14/26]), and acute renal failure (13% [13/98] vs 31% [8/26]) occurred more frequently in nonsurvivors (p<0.05). Multiple logistic regression identified resistance to second- or third-generation cephalosporins (adjusted odds ratio [OR] 5.16, 95% confidence interval [CI] 2.66–10.0, p=0.013), trimethoprim-sulfamethoxazole resistance (adjusted OR 5.44, 95% CI 2.53–11.7, p=0.027), and mechanical ventilation (adjusted OR 12.2, 95% CI 5.99–24.5, p<0.001) as independent determinants of Mortality. Conclusion. Among patients with Enterobacter sp or C. freundii bloodstream infections, those with trimethoprim-sulfamethoxazole-resistant or secondor third-generation cephalosporin-resistant strains or those who required mechanical ventilation had an increased risk of Mortality.
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Predictors of Hospital Mortality for patients with severe sepsis treated with Drotrecogin alfa (activated).
Pharmacotherapy, 2005Co-Authors: Scott T. Micek, Warren Isakow, William D. Shannon, Marin H. KollefAbstract:Study Objective. To identify predictors of Hospital Mortality among patients with severe sepsis who were treated with drotrecogin alfa (activated). Design. Prospective observational cohort study. Setting. A 1400-bed academic medical center. Patients. One hundred two patients treated with drotrecogin alfa (activated) for severe sepsis. Measurements and Main Results. To identify potential risk factors for Hospital Mortality, the main outcome evaluated, all patients who received drotrecogin alfa (activated) were segregated according to Hospital survival. The following characteristics were recorded: age, sex, weight, surgical or nonsurgical, Acute Physiology and Chronic Health Evaluation (APACHE) II score, number of acquired organ-system derangements, mechanical ventilation, use of vasopressors or dobutamine, patient location 24 hours before receiving drotrecogin alfa (activated), source of infection, micro-biologically positive culture, and other process-of-care variables. Of the 102 patients, 43 (42.2%) died during their Hospitalization. Potential predictors of Hospital Mortality identified by univariate analysis included greater APACHE II scores, administration of vasopressin or dobutamine, number of acquired organ-system derangements, time to treatment with drotrecogin alfa (activated), intravenous fluid administered before receiving vasopressors or drotrecogin alfa (activated), number of red blood cell transfusions, and administration of inappropriate initial antimicrobial treatment. Multivariate analysis revealed that vasopressin administration (odds ratio [OR] 3.72, 95% confidence interval [CI] 1.95–7.10), number of acquired organ-system derangements (OR 2.30, 95% CI 1.59–3.31), and administration of inappropriate initial antimicrobial treatment (OR 15.5, 95% CI 6.78–35.6) were independently associated with Hospital Mortality. Conclusion. Number of acquired organ-system derangements, vasopressin administration, and treatment with an inappropriate initial antimicrobial regimen are independently associated with an increased risk of Hospital Mortality among patients treated with drotrecogin alfa (activated) for severe sepsis. These findings suggest that other specific medical interventions may increase survival in this patient population.
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inadequate antimicrobial treatment of infections a risk factor for Hospital Mortality among critically ill patients
Chest, 1999Co-Authors: Marin H. Kollef, Glenda Sherman, Suzanne Ward, Victoria J FraserAbstract:Study objective: To evaluate the relationship between inadequate antimicrobial treatment of infections (both community-acquired and nosocomial infections) and Hospital Mortality for patients requiring ICU admission. Design: Prospective cohort study. Setting: Barnes-Jewish Hospital, a university-affiliated urban teaching Hospital. Patients: Two thousand consecutive patients requiring admission to the medical or surgical ICU. Interventions: Prospective patient surveillance and data collection. Measurements and results: One hundred sixty-nine (8.5%) infected patients received inadequate antimicrobial treatment of their infections. This represented 25.8% of the 655 patients assessed to have either community-acquired or nosocomial infections. The occurrence of inadequate antimicrobial treatment of infection was most common among patients with nosocomial infections, which developed after treatment of a community-acquired infection (45.2%), followed by patients with nosocomial infections alone (34.3%) and patients with community-acquired infections alone (17.1%) (p < 0.001). Multiple logistic regression analysis, using only the cohort of infected patients (n 5 655), demonstrated that the prior administration of antibiotics (adjusted odds ratio [OR], 3.39; 95% confidence interval [CI], 2.88 to 4.23; p < 0.001), presence of a bloodstream infection (adjusted OR, 1.88; 95% CI, 1.52 to 2.32; p 5 0.003), increasing acute physiology and chronic health evaluation (APACHE) II scores (adjusted OR, 1.04; 95% CI, 1.03 to 1.05; p 5 0.002), and decreasing patient age (adjusted OR, 1.01; 95% CI, 1.01 to 1.02; p 5 0.012) were independently associated with the administration of inadequate antimicrobial treatment. The Hospital Mortality rate of infected patients receiving inadequate antimicrobial treatment (52.1%) was statistically greater than the Hospital Mortality rate of the remaining patients in the cohort (n 5 1,831) without this risk factor (12.2%) (relative risk [RR], 4.26; 95% CI, 3.52 to 5.15; p < 0.001). Similarly, the infection-related Mortality rate for infected patients receiving inadequate antimicrobial treatment (42.0%) was significantly greater than the infection-related Mortality rate of infected patients receiving adequate antimicrobial treatment (17.7%) (RR, 2.37; 95% CI, 1.83 to 3.08; p < 0.001). Using a logistic regression model, inadequate antimicrobial treatment of infection was found to be the most important independent determinant of Hospital Mortality for the entire patient cohort (adjusted OR, 4.27; 95% CI, 3.35 to 5.44; p < 0.001). The other identified independent determinants of Hospital Mortality included the number of acquired organ system derangements, use of vasopressor agents, the presence of an underlying malignancy, increasing APACHE II scores, increasing age, and having a nonsurgical diagnosis at the time of ICU admission. Conclusions: Inadequate treatment of infections among patients requiring ICU admission appears to be an important determinant of Hospital Mortality. These data suggest that clinical efforts aimed at reducing the occurrence of inadequate antimicrobial treatment could improve the outcomes of critically ill patients. Additionally, prior antimicrobial therapy should be recognized as an important risk factor for the administration of inadequate antimicrobial treatment among ICU patients with clinically suspected infections. (CHEST 1999; 115:462‐ 474)
Steven A R Webb - One of the best experts on this subject based on the ideXlab platform.
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comparison of acute physiology and chronic health evaluation apache ii score with organ failure scores to predict Hospital Mortality
Anaesthesia, 2007Co-Authors: Kok Y Lee, Teresa A Williams, Judith Finn, Matthew Knuiman, Steven A R WebbAbstract:This study compared the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II score with two organ failure scores in predicting Hospital Mortality of critically ill patients. A total of 1311 consecutive adult patients in a tertiary 22-bed multidisciplinary intensive care unit (ICU) in Western Australia were considered. The APACHE II score had a better calibration and discrimination than the Max Sequential Organ Failure Score (Max SOFA) (area under receiver operating characteristic (ROC) curve 0.858 vs 0.829), Admission SOFA (area under ROC 0.858 vs 0.791), and the first day or cumulative 5-day Royal Perth Hospital Intensive Care Unit (RPHICU) organ failure score (area under ROC 0.858 vs 0.822 and 0.819, respectively) in predicting Hospital Mortality. The APACHE II score predicted Hospital Mortality of critically ill patients better than the SOFA and RPHICU organ failure scores in our ICU.
Chingwei Tsai - One of the best experts on this subject based on the ideXlab platform.
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saps 3 at dialysis commencement is predictive of Hospital Mortality in patients supported by extracorporeal membrane oxygenation and acute dialysis
European Journal of Cardio-Thoracic Surgery, 2008Co-Authors: Yufeng Lin, Chingwei Tsai, Tzongshinn Chu, Yungming ChenAbstract:Objective: This study examined the association between Hospital Mortality and five illness—severity scoring systems evaluated at different time points in the intensive care unit (ICU) as well as clinical variables as predictors in critically ill patients supported by extracorporeal membrane oxygenation (ECMO) and acute dialysis. Methods: This multicenter prospective observational study included 104 patients who received ECMO support and acute dialysis from January 2002 to December 2006. Patients’ demographic, clinical and laboratory variables were analyzed as predictors of survival. The SAPS2, APACHE II, SOFA, MODS, and SAPS 3 scores upon ICU admission and at acute dialysis commencement were evaluated to predict the patient’s Hospital Mortality. Results: Hospital Mortality for the study group was 76% (79/104). Among the five scoringsystems,onlySAPS3score showeda significantdifference betweensurvivors andnon-survivorseitheruponICUadmission(p = 0.038)or at dialysis commencement (p = 0.001). SAPS 3 score at dialysis commencement showed the best discrimination ability by using the area under the receiver operating characteristic curve (SOFA, 0.55; SAPS 2, 0.56; MODS, 0.58; APACHE II, 0.59; and SAPS 3, 0.73). Multiple logistic regression analysis indicated that SAPS 3 score at dialysis commencement (OR: 1.070, 95% CI: 1.016—1.216) and IABP usage before ECMO (OR: 4.181, 95% CI: 1.448—12.075) were two independent risk factors for Hospital Mortality. Conclusions: Among five common ICU scoring systems evaluated at different time points, SAPS 3 at dialysis commencement is the best risk adjustment systems to predict Hospital Mortality in critically ill patients supported by ECMO and acute dialysis. Furthermore, the SAPS 3 score at dialysis commencement and IABP usage before ECMO are two major independent predictors for Hospital Mortality in patients supported by ECMO and acute dialysis. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Alisina Shahi - One of the best experts on this subject based on the ideXlab platform.
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in Hospital Mortality in patients with periprosthetic joint infection
Orthopaedic Proceedings, 2018Co-Authors: Alisina Shahi, Antonia F Chen, Mitchell G Maltenfort, Javad ParviziAbstract:Periprosthetic joint infection (PJI) is one of the most devastating complications of total joint arthroplasty (TJA). Only a few studies have investigated PJI's impact on the most worrisome of all endpoints, Mortality. The purpose of this study was to perform a large-scale study to determine the rates of PJI associated in-Hospital Mortality, and compare it to other surgical procedures.The Nationwide Inpatient Sample was queried from 2002 to 2010 to assess the risk of Mortality for patients undergoing revision for PJI or aseptic failures. Elixhauser comorbidity index and ICD-9 codes were used to obtain patients’ medical conditions and identify PJI. Multiple logistic-regression analyses were used to determine the associated variables with Mortality. In-Hospital Mortality was compared to the followings: coronary-artery bypass graft, mastectomy, prostatectomy, appendectomy, kidney transplant, carotid surgery, cholecystectomy, and coronary interventional procedures.PJI was associated with an increased risk (odd...
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in Hospital Mortality in patients with periprosthetic joint infection
Journal of Arthroplasty, 2017Co-Authors: Alisina Shahi, Antonia F Chen, Mitchell G Maltenfort, Javad ParviziAbstract:Abstract Background While periprosthetic joint infection (PJI) has a huge impact on patient function and health, only a few studies have investigated its impact on Mortality. The purpose of this large-scale study was to (1) determine the rate and trends of in-Hospital Mortality for PJI and (2) compare the in-Hospital Mortality rate of patients with PJI and those undergoing revision arthroplasty for aseptic failure and patients undergoing other nonorthopedic major surgical procedures. Methods Data from the Nationwide Inpatient Sample from 2002 to 2010 were analyzed to determine the risk of in-Hospital Mortality for PJI patients compared with aseptic revision arthroplasty. The Elixhauser comorbidity index was used to obtain patient comorbidities. Multiple logistic regression analyses were used to examine whether PJI and other patient-related factors were associated with Mortality. Results PJI was associated with an increased risk (odds ratio, 2.05; P Conclusion Patients undergoing treatment for PJI have a 2-fold increase in in-Hospital Mortality for each surgical admission compared to aseptic revisions. Considering that PJI cases often have multiple admissions and that this analysis is by surgical admission, the risk of Mortality will accumulate for every additional surgery. Surgeons should be cognizant of the potentially fatal outcome of PJI and the importance of infection control to reduce the risk of Mortality.
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in Hospital Mortality in patients with periprosthetic joint infection
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Alisina Shahi, Antonia F Chen, Mitchell G Maltenfort, Javad ParviziAbstract:Periprosthetic joint infection (PJI) is one of the most devastating complications of total joint arthroplasty (TJA). Only a few studies have investigated PJI9s impact on the most worrisome of all endpoints, Mortality. The purpose of this study was to perform a large-scale study to determine the rates of PJI associated in-Hospital Mortality, and compare it to other surgical procedures. The Nationwide Inpatient Sample was queried from 2002 to 2010 to assess the risk of Mortality for patients undergoing revision for PJI or aseptic failures. Elixhauser comorbidity index and ICD-9 codes were used to obtain patients’ medical conditions and identify PJI. Multiple logistic-regression analyses were used to determine the associated variables with Mortality. In-Hospital Mortality was compared to the followings: coronary-artery bypass graft, mastectomy, prostatectomy, appendectomy, kidney transplant, carotid surgery, cholecystectomy, and coronary interventional procedures. PJI was associated with an increased risk (odds ratio 2.04) of in-Hospital Mortality (0.77%) compared to aseptic revisions (0.38%). The in-Hospital Mortality of revision THAs done for PJI (1.38%, 95%CI, 1.12–1.64%) was comparable to or higher than interventional coronary procedure (1.22%, 95%CI, 1.20–1.24%), cholecystectomy (1.13%, 95%CI, 1.11–1.15%), kidney transplantation (0.70%, 95%CI, 0.61%–0.79%) and carotid surgery (0.89%, 95%CI, 0.86%–0.93%) (Figure 1). The following comorbidities were independent risk factors for in-Hospital Mortality after TJA: liver disease, metastatic disease, fluid and electrolyte disorders, coagulopathy, weight loss and malnutrition, congestive heart failure, pulmonary circulation disorder, renal failure, and peripheral vascular disease. PJI is associated with a two-fold increase in Mortality and have Mortality rates comparable to kidney transplantation and carotid surgery. Considering the fact that patients with PJI often require multiple surgical procedures, the rate of actual in-Hospital Mortality for patients with PJI may be considerably higher. Surgeons should be cognizant of the potentially fatal outcome of PJI and must emphasize the importance of infection control to reduce the risk of Mortality.