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Ioannis K Toumpoulis - One of the best experts on this subject based on the ideXlab platform.
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does euroscore predict Length of Stay and specific postoperative complications after coronary artery bypass grafting
2005Co-Authors: Ioannis K Toumpoulis, Constantine E Anagnostopoulos, Joseph J Derose, Daniel G SwistelAbstract:Abstract Background To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative Length of Stay and specific major postoperative complications after coronary artery bypass grafting (CABG). Methods Data on 3760 consecutive patients with CABG were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, prolonged Length of Stay (>12 days) and major postoperative complications (stroke, myocardial infarction, sternal infection, bleeding, sepsis and/or endocarditis, gastrointestinal complications, renal and respiratory failure). A C statistic (receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer–Lemeshow goodness-of-fit statistic. Results In-hospital mortality was 2.7%, and 13.7% of patients had one or more major complications. EuroSCORE showed very good discriminatory ability in predicting renal failure ( C statistic: 0.80) and good discriminatory ability in predicting in-hospital mortality ( C statistic: 0.75), sepsis and/or endocarditis ( C statistic: 0.72) and prolonged Length of Stay ( C statistic: 0.71). There were no differences in terms of the discriminatory ability between standard and logistic EuroSCORE. Standard EuroSCORE showed good calibration (Hosmer–Lemeshow: P >0.05) in predicting these outcomes except for postoperative Length of Stay, while logistic EuroSCORE showed good calibration only in predicting renal failure. Conclusions EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also prolonged Length of Stay and specific postoperative complications such as renal failure and sepsis and/or endocarditis after CABG. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation.
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does euroscore predict Length of Stay and specific postoperative complications after cardiac surgery
2005Co-Authors: Ioannis K Toumpoulis, Constantine E Anagnostopoulos, Daniel G Swistel, Joseph J DeroseAbstract:Objective: To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative Length of Stay and specific major postoperative complications after cardiac surgery. Methods: Data on 5051 consecutive patients (isolated [74.4%] or combined coronary artery bypass grafting [11.1%], valve surgery [12.0%] and thoracic aortic surgery [2.5%]) were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, 3-month mortality, prolonged Length of Stay (O12 days) and major postoperative complications (intraoperative stroke, stroke over 24 h, postoperative myocardial infarction, deep sternal wound infection, re-exploration for bleeding, sepsis and/or endocarditis, gastrointestinal complications, postoperative renal failure and respiratory failure). A C statistic (or the area under the receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer‐Lemeshow goodness-of-fit statistic. Results: In-hospital mortality was 3.9% and 16.1% of patients had one or more major complications. Standard EuroSCORE showed very good discriminatory ability and good calibration in predicting in-hospital mortality (C statistic: 0.76, Hosmer‐Lemeshow: PZ0.449) and postoperative renal failure (C statistic: 0.79, Hosmer‐Lemeshow: PZ0.089) and good discriminatory ability in predicting sepsis and/or endocarditis (C statistic: 0.74, Hosmer‐Lemeshow: PZ0.653), 3-month mortality (C statistic: 0.73, Hosmer‐ Lemeshow: PZ0.097), prolonged Length of Stay (C statistic: 0.71, Hosmer‐Lemeshow: PZ0.051) and respiratory failure (C statistic: 0.71, Hosmer‐Lemeshow: PZ0.714). There were no differences in terms of the discriminatory ability in predicting these outcomes between standard and logistic EuroSCORE. However, logistic EuroSCORE showed no calibration (Hosmer‐Lemeshow: P!0.05) except for sepsis and/or endocarditis (Hosmer‐Lemeshow: PZ0.078). EuroSCORE was unable to predict other major complications such as intraoperative stroke, stroke over 24 h, postoperative myocardial infarction, deep sternal wound infection, gastrointestinal complications and re-exploration for bleeding. Conclusions: EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also 3-month mortality, prolonged Length of Stay and specific postoperative complications such as renal failure, sepsis and/or endocarditis and respiratory failure in the whole context of cardiac surgery. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation. q 2004 Elsevier B.V. All rights reserved.
Constantine E Anagnostopoulos - One of the best experts on this subject based on the ideXlab platform.
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does euroscore predict Length of Stay and specific postoperative complications after coronary artery bypass grafting
2005Co-Authors: Ioannis K Toumpoulis, Constantine E Anagnostopoulos, Joseph J Derose, Daniel G SwistelAbstract:Abstract Background To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative Length of Stay and specific major postoperative complications after coronary artery bypass grafting (CABG). Methods Data on 3760 consecutive patients with CABG were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, prolonged Length of Stay (>12 days) and major postoperative complications (stroke, myocardial infarction, sternal infection, bleeding, sepsis and/or endocarditis, gastrointestinal complications, renal and respiratory failure). A C statistic (receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer–Lemeshow goodness-of-fit statistic. Results In-hospital mortality was 2.7%, and 13.7% of patients had one or more major complications. EuroSCORE showed very good discriminatory ability in predicting renal failure ( C statistic: 0.80) and good discriminatory ability in predicting in-hospital mortality ( C statistic: 0.75), sepsis and/or endocarditis ( C statistic: 0.72) and prolonged Length of Stay ( C statistic: 0.71). There were no differences in terms of the discriminatory ability between standard and logistic EuroSCORE. Standard EuroSCORE showed good calibration (Hosmer–Lemeshow: P >0.05) in predicting these outcomes except for postoperative Length of Stay, while logistic EuroSCORE showed good calibration only in predicting renal failure. Conclusions EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also prolonged Length of Stay and specific postoperative complications such as renal failure and sepsis and/or endocarditis after CABG. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation.
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does euroscore predict Length of Stay and specific postoperative complications after cardiac surgery
2005Co-Authors: Ioannis K Toumpoulis, Constantine E Anagnostopoulos, Daniel G Swistel, Joseph J DeroseAbstract:Objective: To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative Length of Stay and specific major postoperative complications after cardiac surgery. Methods: Data on 5051 consecutive patients (isolated [74.4%] or combined coronary artery bypass grafting [11.1%], valve surgery [12.0%] and thoracic aortic surgery [2.5%]) were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, 3-month mortality, prolonged Length of Stay (O12 days) and major postoperative complications (intraoperative stroke, stroke over 24 h, postoperative myocardial infarction, deep sternal wound infection, re-exploration for bleeding, sepsis and/or endocarditis, gastrointestinal complications, postoperative renal failure and respiratory failure). A C statistic (or the area under the receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer‐Lemeshow goodness-of-fit statistic. Results: In-hospital mortality was 3.9% and 16.1% of patients had one or more major complications. Standard EuroSCORE showed very good discriminatory ability and good calibration in predicting in-hospital mortality (C statistic: 0.76, Hosmer‐Lemeshow: PZ0.449) and postoperative renal failure (C statistic: 0.79, Hosmer‐Lemeshow: PZ0.089) and good discriminatory ability in predicting sepsis and/or endocarditis (C statistic: 0.74, Hosmer‐Lemeshow: PZ0.653), 3-month mortality (C statistic: 0.73, Hosmer‐ Lemeshow: PZ0.097), prolonged Length of Stay (C statistic: 0.71, Hosmer‐Lemeshow: PZ0.051) and respiratory failure (C statistic: 0.71, Hosmer‐Lemeshow: PZ0.714). There were no differences in terms of the discriminatory ability in predicting these outcomes between standard and logistic EuroSCORE. However, logistic EuroSCORE showed no calibration (Hosmer‐Lemeshow: P!0.05) except for sepsis and/or endocarditis (Hosmer‐Lemeshow: PZ0.078). EuroSCORE was unable to predict other major complications such as intraoperative stroke, stroke over 24 h, postoperative myocardial infarction, deep sternal wound infection, gastrointestinal complications and re-exploration for bleeding. Conclusions: EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also 3-month mortality, prolonged Length of Stay and specific postoperative complications such as renal failure, sepsis and/or endocarditis and respiratory failure in the whole context of cardiac surgery. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation. q 2004 Elsevier B.V. All rights reserved.
Marin H Kollef - One of the best experts on this subject based on the ideXlab platform.
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inappropriate antibiotic therapy in gram negative sepsis increases hospital Length of Stay
2011Co-Authors: Andrew F Shorr, Scott T Micek, Emily C Welch, Joshua A Doherty, Richard M Reichley, Marin H KollefAbstract:OBJECTIVES: To describe the impact of initially inappropriate antibiotic therapy on hospital Length of Stay in Gram-negative severe sepsis and septic shock. DESIGN: Retrospective cohort. SETTING: Academic urban hospital. PATIENTS: Patients with Gram-negative bacteremia (primary or secondary, nosocomial or non-nosocomial) and severe sepsis or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We defined initially inappropriate antibiotic therapy as occurring when the patient either was not administered an antibiotic within 24 hrs of sepsis onset or was treated with an antibiotic to which the culprit pathogen was resistant in vitro. The cohort included 760 subjects (mean age 59.3 ± 16.3 yrs, mean Acute Physiology and Chronic Health Evaluation II score 23.7 ± 6.7). More than half of infections were nosocomial (55.1%), and Escherichia coli represented the most common pathogen (n = 225). Pseudomonas species were isolated in 17.4% of patients. Nearly one-third of patients (31.3%) received initially inappropriate antibiotic therapy. Patients administered initially inappropriate antibiotic therapy were more likely to have a nosocomial infection, to have underlying cancer or diabetes or both, to require chronic hemodialysis, and to undergo mechanical ventilation. Those administered initially inappropriate antibiotic therapy also faced higher inhospital mortality. The unadjusted median Length of Stay after sepsis onset in those administered initially inappropriate antibiotic therapy was 11 days compared to 9 days in those treated appropriately (p = .028 by log-rank test). In a Cox model controlling for the multiple confounders noted, initially inappropriate antibiotic therapy independently correlated with continued hospitalization (adjusted hazard ratio 1.19, 95% confidence interval 1.01-1.40, p = .044). Adjusting for these covariates indicated that initially inappropriate antibiotic therapy independently increased the median attributable Length of Stay by 2 days. CONCLUSIONS: Initially inappropriate antibiotic therapy occurs in one-third of persons with severe sepsis and septic shock attributable to Gram-negative organisms. Beyond its impact on mortality, initially inappropriate antibiotic therapy is significantly associated with Length of Stay in this population. Efforts to decrease rates of initially inappropriate antibiotic therapy may serve to improve hospital resource use by leading to shorter overall hospital Stays.
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inappropriate antibiotic therapy in gram negative sepsis increases hospital Length of Stay
2011Co-Authors: Andrew F Shorr, Scott T Micek, Emily C Welch, Joshua A Doherty, Richard M Reichley, Marin H KollefAbstract:Objectives:To describe the impact of initially inappropriate antibiotic therapy on hospital Length of Stay in Gram-negative severe sepsis and septic shock.Design:Retrospective cohort.Setting:Academic urban hospital.Patients:Patients with Gram-negative bacteremia (primary or secondary, nosocomial or
James L Januzzi - One of the best experts on this subject based on the ideXlab platform.
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postoperative troponin t predicts prolonged intensive care unit Length of Stay following cardiac surgery
2004Co-Authors: Aaron L Baggish, Thomas E Macgillivray, William D Hoffman, John B Newell, Kent B Lewandrowski, Elizabeth Leelewandrowski, Saif Anwaruddin, Uwe Siebert, James L JanuzziAbstract:Objective: To evaluate the use of postoperative cardiac troponin T (cTnT) for the prediction of prolonged intensive care unit Length of Stay following cardiac surgery. Design: Prospective, single-center, observational cohort study of patients following cardiac surgical procedures. The enrollment period was from October through December 2000. Patients were enrolled on admission to the intensive care unit and followed until hospital discharge. Setting: The cardiac surgical intensive care unit of the Massachusetts General Hospital. Patients: A total of 222 consecutive patients were enrolled. Interventions: None. Measurements and Main Results: Perioperative clinical factors and serum concentrations of cTnT measured every 8 hrs after surgery were recorded. These clinical factors and the results of serum cTnT measurement were correlated with the need for prolonged intensive care unit Length of Stay (defined as >24 hrs). Univariable analysis identified factors predictive of prolonged intensive care unit Length of Stay. Stepwise logistic regression identified independent predictors of prolonged intensive care unit Length of Stay. Multiple linear regression was used to explore the direct relationship between cTnT concentrations at several postoperative time points and intensive care unit Length of Stay. At each time point assessed, cTnT concentrations from patients requiring a prolonged intensive care unit Length of Stay were significantly higher (all p <.001) than in those individuals with normal Length of Stay. In contrast, creatine kinase isoenzymes were not significantly different between patients with normal or prolonged intensive care unit Length of Stay. Multivariable analysis demonstrated that an immediate postoperative cTnT concentration ≥1.58 ng/mL was the strongest predictor of a prolonged intensive care unit Length of Stay (odds ratio, 5.6; 95% confidence interval, 2.9-10.8). Multiple linear regression analysis revealed that intensive care unit Length of Stay increased by 0.32 days with each incremental 1.0 ng/mL increase in cTnT measured at 18-24 hrs postprocedure. Conclusions: Elevated postoperative cTnT concentrations can prospectively identify patients requiring prolonged intensive care unit Length of Stay after cardiac surgery.
Daniel G Swistel - One of the best experts on this subject based on the ideXlab platform.
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does euroscore predict Length of Stay and specific postoperative complications after coronary artery bypass grafting
2005Co-Authors: Ioannis K Toumpoulis, Constantine E Anagnostopoulos, Joseph J Derose, Daniel G SwistelAbstract:Abstract Background To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative Length of Stay and specific major postoperative complications after coronary artery bypass grafting (CABG). Methods Data on 3760 consecutive patients with CABG were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, prolonged Length of Stay (>12 days) and major postoperative complications (stroke, myocardial infarction, sternal infection, bleeding, sepsis and/or endocarditis, gastrointestinal complications, renal and respiratory failure). A C statistic (receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer–Lemeshow goodness-of-fit statistic. Results In-hospital mortality was 2.7%, and 13.7% of patients had one or more major complications. EuroSCORE showed very good discriminatory ability in predicting renal failure ( C statistic: 0.80) and good discriminatory ability in predicting in-hospital mortality ( C statistic: 0.75), sepsis and/or endocarditis ( C statistic: 0.72) and prolonged Length of Stay ( C statistic: 0.71). There were no differences in terms of the discriminatory ability between standard and logistic EuroSCORE. Standard EuroSCORE showed good calibration (Hosmer–Lemeshow: P >0.05) in predicting these outcomes except for postoperative Length of Stay, while logistic EuroSCORE showed good calibration only in predicting renal failure. Conclusions EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also prolonged Length of Stay and specific postoperative complications such as renal failure and sepsis and/or endocarditis after CABG. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation.
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does euroscore predict Length of Stay and specific postoperative complications after cardiac surgery
2005Co-Authors: Ioannis K Toumpoulis, Constantine E Anagnostopoulos, Daniel G Swistel, Joseph J DeroseAbstract:Objective: To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative Length of Stay and specific major postoperative complications after cardiac surgery. Methods: Data on 5051 consecutive patients (isolated [74.4%] or combined coronary artery bypass grafting [11.1%], valve surgery [12.0%] and thoracic aortic surgery [2.5%]) were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, 3-month mortality, prolonged Length of Stay (O12 days) and major postoperative complications (intraoperative stroke, stroke over 24 h, postoperative myocardial infarction, deep sternal wound infection, re-exploration for bleeding, sepsis and/or endocarditis, gastrointestinal complications, postoperative renal failure and respiratory failure). A C statistic (or the area under the receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer‐Lemeshow goodness-of-fit statistic. Results: In-hospital mortality was 3.9% and 16.1% of patients had one or more major complications. Standard EuroSCORE showed very good discriminatory ability and good calibration in predicting in-hospital mortality (C statistic: 0.76, Hosmer‐Lemeshow: PZ0.449) and postoperative renal failure (C statistic: 0.79, Hosmer‐Lemeshow: PZ0.089) and good discriminatory ability in predicting sepsis and/or endocarditis (C statistic: 0.74, Hosmer‐Lemeshow: PZ0.653), 3-month mortality (C statistic: 0.73, Hosmer‐ Lemeshow: PZ0.097), prolonged Length of Stay (C statistic: 0.71, Hosmer‐Lemeshow: PZ0.051) and respiratory failure (C statistic: 0.71, Hosmer‐Lemeshow: PZ0.714). There were no differences in terms of the discriminatory ability in predicting these outcomes between standard and logistic EuroSCORE. However, logistic EuroSCORE showed no calibration (Hosmer‐Lemeshow: P!0.05) except for sepsis and/or endocarditis (Hosmer‐Lemeshow: PZ0.078). EuroSCORE was unable to predict other major complications such as intraoperative stroke, stroke over 24 h, postoperative myocardial infarction, deep sternal wound infection, gastrointestinal complications and re-exploration for bleeding. Conclusions: EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also 3-month mortality, prolonged Length of Stay and specific postoperative complications such as renal failure, sepsis and/or endocarditis and respiratory failure in the whole context of cardiac surgery. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation. q 2004 Elsevier B.V. All rights reserved.
