scholarly journals What Leads to a Patient Refusal for Ambulatory Surgery? A Logistic Regression Prediction Model Based on a 5-year Retrospective Analysis of Patients with Abdominal Wall Hernia

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
João Oliveira ◽  
Sandra F. Ramos ◽  
Manuel B. Cruz ◽  
Isabel Novais ◽  
Carlos Magalhães ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Abdominal Surgery ◽  
Predictive Value ◽  
Ambulatory Surgery ◽  
Risk Index ◽  
Abdominal Hernia ◽  
Mathematical Tool ◽  
Physical Status ◽  
Patient Refusal

Introduction: Ambulatory surgery has proven benefits in patient wellbeing and cost reduction in healthcare systems. However, some patients referred for ambulatory surgery are refused and directed instead towards inpatient care, which generates several drawbacks. The reasons for this refusal have not been yet studied. The aim of this study is to identify, retrospectively, significant variables associated with patient refusal for ambulatory surgery and develop a mathematical tool able to predict with strong accuracy those who will be rejected.Material and Methods: Over a 5-year period (2014 - 2018), all patients that underwent abdominal hernia repair in our hospital in an inpatient setting, and that had been previously refused for ambulatory surgery, were analysed for a total of 94 variables. A multivariate logistic regression model was developed to identify risk factors associated with refusal using data from 136 patients (65 refused vs 71 accepted). A prediction index for refusal in ambulatory surgery - IRAS - was derived and tested (n = 62 patients).Results: The risk index included five significant risk factors: type 2 diabetes mellitus [OR 14.669 (2.982; 72.154)], physical status [OR 49.155 (15.532; 155.555)], prior malignancy [OR 14.518 (2.653; 79.441)], prior abdominal surgery [OR 3.455 (1.006; 11.866)] and usage of antiplatelet agents [OR 25.600 (4.309; 152.066)]. All risk factors were associated with a high risk of refusal (OR between 3.455 for history of prior abdominal surgery and 49.155 according to the American Society of Anaesthesiologists physical status classification). Defining five points as the maximum IRAS score that predicts suitability for ambulatory surgery resulted in a positive predictive value of 93.55% and negative predictive value of 87.10%.Discussion: Significant patient variables for refusal of an ambulatory procedure were determined and an easy to use risk index - IRAS - was built that is able to predict with good accuracy which patients will be refused.Conclusion: IRAS is a useful tool that can contribute to reduce time to surgery and improve patients’ quality of life.

scholarly journals Language Delay Is Not Predictable from Available Risk Factors

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Philip Wilson ◽  
Fiona McQuaige ◽  
Lucy Thompson ◽  
Alex McConnachie
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Male Gender ◽  
Language Delay ◽  
Predictive Capacity ◽  
Factors Associated ◽  
Health Visitors

Aims. To investigate factors associated with language delay in a cohort of 30-month-old children and determine if identification of language delay requires active contact with families.Methods. Data were collected at a pilot universal 30-month health contact. Health visitors used a simple two-item language screen. Data were obtained for 315 children; language delay was found in 33. The predictive capacity of 13 variables which could realistically be known before the 30-month contact was analysed.Results. Seven variables were significantly associated with language delay in univariate analysis, but in logistic regression only five of these variables remained significant.Conclusion. The presence of one or more risk factors had a sensitivity of 89% and specificity of 45%, but a positive predictive value of only 15%. The presence of one or more of these risk factors thus can not reliably be used to identify language delayed children, nor is it possible to define an “at risk” population because male gender was the only significant demographic factor and it had an unacceptably low specificity (52.5%). It is not possible to predict which children will have language delay at 30 months. Identification of this important ESSENCE disorder requires direct clinical contact with all families.

scholarly journals Association of Biomarkers Related to Preoperative Inflammatory and Coagulation with Postoperative In-Hospital Deaths in Patients with Type A Acute Aortic Dissection

2021 ◽  
Author(s):  
Ming Li ◽  
Haifeng Sun ◽  
Suochun Xu ◽  
Yang Yan ◽  
Haichen Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Predictive Value ◽  
Multivariate Logistic Regression Analysis ◽  
Type A ◽  
Hospital Deaths ◽  
Independent Risk Factors ◽  
D Dimer

Abstract Background: The aim of this study was to analyze the predictive value of biomarkers related to preoperative inflammatory and coagulation in the prognosis of patients with type A acute aortic dissection (AAD). Methods: A total of 206 patients with type A AAD who had received surgical treatment were enrolled. Patients were divided into two groups according to whether they died during hospitalization. Peripheral blood samples were collected before anesthesia induction. Preoperative levels of D-dimer, fibrinogen (FIB), platelet (PLT), white blood cells (WBC) and neutrophil (NEU) between the two groups were compared. Univariate and multivariate logistic regression analysis were utilized to identify the independent risk factors for postoperative in-hospital deaths of patients with type A AAD. Receiver operating characteristic (ROC) curve were used to analyze the predictive value of D-dimer, FIB, PLT, WBC, NEU and CRP in the prognosis of the patients. Results: Univariate logistic regression analysis showed that the P values of the five parameters including D-dimer, FIB, PLT, WBC and NEU were all less than 0.1, which may be risk factors for postoperative in-hospital deaths of patients with type A AAD. Further multivariate logistic regression analysis indicated that higher preoperative D-dimer and WBC levels were independent risk factors for in-hospital deaths of patients with type A AAD. ROC curve analysis indicated that FIB+PLT combination is provided with the highest predictive value for in-hospital deaths.Conclusion: Both preoperative D-dimer and WBC in patients with type A AAD may be used as independent risk factors for the prognosis of such patients. Combined use of FIB and PLT may improve the accuracy and accessibility of clinical prognostic assessment.

scholarly journals The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

2020 ◽  
Author(s):  
Soohyuk Yoon ◽  
Seokha Yoo ◽  
Min Hur ◽  
Sun-Kyung Park ◽  
Hyung-Chul Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Retrospective Study ◽  
Abdominal Surgery ◽  
Bispectral Index ◽  
Odds Ratio ◽  
Postoperative Mortality ◽  
Anesthetic Depth ◽  
Cumulative Duration ◽  
Cumulative Time

Abstract Background The influence of intraoperative low bispectral index (BIS) values and hypotension on poor clinical outcomes has been controversial. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods This retrospective study analyzed 1,862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 minutes. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results Ninety-day mortality and 180-day mortality were 1.5% and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions Delicate adjustment of anesthetic depth is important to avoid excessive brain suppression and hypotension, which could be associated with postoperative mortality.

scholarly journals Surgical Site Infection After Emergency Abdominal Surgery in China: A Multicenter Prospective Study

2020 ◽  
Author(s):  
Ze Li ◽  
Hui Li ◽  
Pin Lv ◽  
Xingang Peng ◽  
Changliang Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Secondary Outcome ◽  
Microbial Culture ◽  
Site Infection ◽  
High Blood Glucose ◽  
Emergency Abdominal Surgery

Abstract Background There is still a lack of relevant studies on surgical site infection (SSI) after emergency abdominal surgery (EAS) in China. This study aims to understand the status of SSI after EAS in China and discuss its risk factors. Materials and Methods All adult patients who underwent EAS in 47 hospitals in China from May 1 to 31, 2018, and from May 1 to June 7, 2019, were enrolled in this study. The basic information, perioperative data, and microbial culture results of infected incision were prospectively collected.The primary outcome measure was the incidence of SSI after EAS, and the secondary outcome variables were postoperative length of stay, ICU admission rate, ICU length of stay, 30-day postoperative mortality, and treatment costs. Univariate and multivariate logistic regression were used to analyze the risk factors.Results A total of 953 patients (age 48.8 ± 17.9 years, male 51.9%) with EAS were included in this study: 71 patients (7.5%) developed SSI after surgery.The main pathogen of SSI was Escherichia coli (culture positive rate 29.6%). Patients with SSI had significantly longer overall hospital (p < 0.001) and ICU stays (p < 0.001), significantly higher ICU admissions (p < 0.001), and medical costs (p < 0.001) than patients without SSI.Multivariate logistic regression analysis showed that male (P = 0.010), high blood glucose level (P < 0.001), colorectal surgery (P < 0.001), intestinal obstruction (P = 0.045) and surgical duration (P = 0.007) were risk factors for SSI, whereas laparoscopic surgery (P < 0.001 = 0.022) was a protective factor. Conclusion This study found a high incidence of SSI after EAS in China. The occurrence of SSI prolongs the patient's hospital stay and increases the medical burden. The study also revealed predictors of SSI after EAS and provides a basis for the development of norms for the prevention of surgical site infection after emergency abdominal surgery.

scholarly journals Predictive value of the sequential organ failure assessment (SOFA) score for prognosis in patients with severe acute ischemic stroke: a retrospective study

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052095010
Author(s):  
Wei Qin ◽  
Xiaoyu Zhang ◽  
Lei Yang ◽  
Yue Li ◽  
Shuna Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Urinary Tract Infection ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Sofa Score ◽  
Predictive Value ◽  
Early Death ◽  
Failure Assessment

Objective To identify the risk factors for early death and determine the predictive value of the sequential organ failure assessment (SOFA) score for prognosis of severe acute ischemic stroke (AIS). Methods A total of 110 patients with severe AIS were enrolled and divided into the non-survivor (n = 34) and survivor groups (n = 76). Logistic regression analysis was conducted to identify risk factors for early death, while the receiver operator characteristic (ROC) curve was used to determine the predictive effect of the SOFA score on prognosis. Results Logistic regression analysis showed that urinary tract infection (odds ratio [OR] = 17.364, 95% confidence interval [CI]: 1.903–158.427), mechanical ventilation (OR = 1.754, 95% CI: 1.648–2.219), and osmotic therapy (OR = 2.835, 95% CI: 1.871–5.102) were significantly correlated with early death of severe AIS. ROC curve analysis of the area under the curve after hospitalization showed that the maximum SOFA and ΔSOFA scores exceeded 0.7. Conclusion Our study shows that urinary tract infection, mechanical ventilation, and osmotic therapy are risk factors for early death of severe AIS. The SOFA score has good predictive value for prognosis of severe AIS. These findings may provide a guideline for improving clinical outcome.

scholarly journals Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery — an analysis of 9,342 blocks

2004 ◽  
Vol 51 (8) ◽  
pp. 810-816 ◽  
Author(s):  
Juliann T. Cotter ◽  
Karen C. Nielsen ◽  
Ulrich Guller ◽  
Susan M. Steele ◽  
Stephen M. Klein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Body Mass ◽  
Ambulatory Surgery ◽  
Physical Status

scholarly journals Prospective multicenter study on the incidence of surgical site infection after emergency abdominal surgery in China

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ze Li ◽  
Hui Li ◽  
Pin Lv ◽  
Xingang Peng ◽  
Changliang Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Secondary Outcome ◽  
Site Infection ◽  
Multivariate Logistic Regression ◽  
High Blood Glucose ◽  
Emergency Abdominal Surgery

AbstractThere is still a lack of relevant studies on surgical site infection (SSI) after emergency abdominal surgery (EAS) in China. This study aims to understand the incidence of SSI after EAS in China and discuss its risk factors. All adult patients who underwent EAS in 47 hospitals in China from May 1 to 31, 2018, and from May 1 to June 7, 2019, were enrolled in this study. The basic information, perioperative data, and microbial culture results of infected incision were prospectively collected. The primary outcome measure was the incidence of SSI after EAS, and the secondary outcome variables were postoperative length of stay, ICU admission rate, ICU length of stay, 30-day postoperative mortality, and hospitalization cost. Univariate and multivariate logistic regression were used to analyze the risk factors. The results were expressed as the odds ratio and 95% confidence interval. A total of 953 patients [age 48.8 (SD: 17.9), male 51.9%] with EAS were included in this study: 71 patients (7.5%) developed SSI after surgery. The main pathogen of SSI was Escherichia coli (culture positive rate 29.6%). Patients with SSI had significantly longer overall hospital (p < 0.001) and ICU stays (p < 0.001), significantly higher ICU admissions (p < 0.001), and medical costs (p < 0.001) than patients without SSI. Multivariate logistic regression analysis showed that male (P = 0.010), high blood glucose level (P < 0.001), colorectal surgery (P < 0.001), intestinal obstruction (P = 0.045) and surgical duration (P = 0.007) were risk factors for SSI, whereas laparoscopic surgery (P < 0.001) was a protective factor. This study found a high incidence of SSI after EAS in China. The occurrence of SSI prolongs the patient's hospital stay and increases the medical burden. The study also revealed predictors of SSI after EAS and provides a basis for the development of norms for the prevention of surgical site infection after emergency abdominal surgery.

scholarly journals Based on a Decision Tree Model for Exploring the Risk Factors of Smartphone Addiction Among Children and Adolescents in China During the COVID-19 Pandemic

2021 ◽  
Vol 12 ◽  
Author(s):  
Li Duan ◽  
Juan He ◽  
Min Li ◽  
Jiali Dai ◽  
Yurong Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Decision Tree ◽  
Children And Adolescents ◽  
Predictive Value ◽  
Mainland China ◽  
Decision Tree Model ◽  
Smartphone Addiction ◽  
Physical And Mental Health ◽  
Tree Model

Background: Smartphone addiction has emerged as a major concern among children and adolescents over the past few decades and may be heightened by the outbreak of COVID-19, posing a threat to their physical and mental health. Then we aimed to develop a decision tree model as a screening tool for unrecognized smartphone addiction by conducting large sample investigation in mainland China.Methods: The data from cross-sectional investigation of smartphone addiction among children and adolescents in mainland China (n = 3,615) was used to build models of smartphone addiction by employing logistic regression, visualized nomogram, and decision tree analysis.Results: Smartphone addiction was found in 849 (23.5%) of the 3,615 respondents. According to the results of logistic regression, nomogram, and decision tree analyses, Internet addiction, hours spend on smartphone during the epidemic, levels of clinical anxiety symptoms, fear of physical injury, and sex were used in predictive model of smartphone addiction among children and adolescents. The C-index of the final adjusted model of logistic regression was 0.804. The classification accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and AUC area of decision tree for detecting smartphone addiction were 87.3, 71.4, 92.1, 73.5, 91.4, and 0.884, respectively.Conclusions: It was found that the incidence of smartphone addiction among children and adolescents is significant during the epidemic. The decision tree model can be used to screen smartphone addiction among them. Findings of the five risk factors will help researchers and parents assess the risk of smartphone addiction quickly and easily.

Finding a Method for Optimizing Risk Adjustment When Comparing Surgical-Site Infection Rates

2004 ◽  
Vol 25 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Christian Brandt ◽  
Sonja Hansen ◽  
Dorit Sohr ◽  
Franz Daschner ◽  
Henning Rüden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Surgical Site Infection ◽  
Regression Models ◽  
Predictive Power ◽  
Risk Index ◽  
Significant Risk ◽  
Site Infection ◽  
Logistic Regression Models ◽  
System Risk

AbstractObjective:To investigate whether stratification of the risk of developing a surgical-site infection (SSI) is improved when a logistic regression model is used to weight the risk factors for each procedure category individually instead of the modified NNIS System risk index.Design and Setting:The German Nosocomial Infection Surveillance System, based on NNIS System methodology, has 273 acute care surgical departments participating voluntarily. Data on 9 procedure categories were included (214,271 operations).Methods:For each of the procedure categories, the significant risk factors from the available data (NNIS System risk index variables of ASA score, wound class, duration of operation, and endoscope use, as well as gender and age) were identified by multiple logistic regression analyses with stepwise variable selection. The area under the receiver operating characteristic (ROC) curve resulting from these analyses was used to evaluate the predictive power of logistic regression models.Results:For most procedures, at least two of the three variables contributing to the NNIS System risk index were shown to be independent risk factors (appendectomy, knee arthroscopy, cholecystectomy, colon surgery, herniorrhaphy, hip prosthesis, knee prosthesis, and vascular surgery). The predictive power of logistic regression models (including age and gender, when appropriate) was low (between 0.55 and 0.71) and for most procedures only slightly better than that of the NNIS System risk index.Conclusion:Without the inclusion of additional procedure-specific variables, logistic regression models do not improve the comparison of SSI rates from various hospitals.

Postoperative Cognitive Dysfunction Induced by Different Surgical Methods and Its Risk Factors

2018 ◽  
Vol 84 (9) ◽  
pp. 1531-1537 ◽  
Author(s):  
Guo-Liang Gong ◽  
Bin Liu ◽  
Jia-Xuan Wu ◽  
Ji-Yuan Li ◽  
Bai-Qing Shu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Analogue Scale ◽  
Postoperative Cognitive Dysfunction ◽  
Perioperative Hypothermia ◽  
Surgical Methods ◽  
Scale Scores ◽  
The Difference

The aim of the present study was to compare the effect of different surgical methods on postoperative cognitive function in patients undergoing abdominal surgery, determine the risk factors of postoperative cognitive dysfunction (POCD) by logistic regression, and investigate these risk factors through different surgical methods. A total of 70 patients undergoing selective abdominal surgery were selected into this study. The age of these patients ranged within 32 to 85 years. The cognitive function of these patients was assessed by the mini-mental state examination at one day before the operation, and at the first and seventh day after the operation. The temperature of the tympanic membrane, PETCO2 values, visual analogue scale scores, educational level, and operation time were recorded. Logistic regression analysis was used to analyze related factors of POCD. The incidence rate of perioperative hypothermia in groups O and L were 31.2 and 10.5 per cent, respectively; and the difference was statistically significant (P < 0.05). The difference in visual analogue scale scores at the first and seventh day after the operation between these two groups were statistically significant (P < 0.01). The incidence of POCD in group O was significantly higher than that in group L at the first and seventh day after the operation (P < 0.05). According to logistic regression results, it was found that age, perioperative hypothermia, and postoperative pain were risk factors of POCD. The difference in POCD for the patients undergoing abdominal surgery through different surgical methods was statistically significant, and this was closely correlated to perioperative hypothermia and postoperative pain.

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