Biomedical subjects

Rachel Rapaport Kelz

Publications and source records attributed to Rachel Rapaport Kelz.

3 recordsLinked to original sources

PubMed2005

Changes in prognosis after the first postoperative complication.

BACKGROUND: Postoperative complications are common in the Medicare population, yet no study has formally quantified the change in prognosis that occurs after a broad range of first complications. OBJECTIVE: We sought to estimate the relative severity of 24 first postoperative complications. RESEARCH DESIGN: We undertook a multivariate matched, population-based, case-control study of death after surgery in a sample of 1362 Pennsylvania Medicare patients. SUBJECTS: Cases (681 deaths) were selected randomly using claims from 1995-1996. Models were developed to scan all Pennsylvania claims, looking for similar controls that did not die. MEASURES: Charts were abstracted, complications identified, and models were constructed to estimate the odds of dying after any 1 of 24 first postoperative complications. RESULTS: The odds of dying within 60 days increased 3.4-fold (95% confidence interval [CI] 2.5-4.7) in patients with complications as compared with those without complications. A first complication of respiratory compromise was associated with a 7.2-fold increase in the odds of dying (95% CI 4.5-11.6). The first complications of pneumonia or congestive heart failure were associated with, respectively, 5-fold (95% CI 2.1-12.1) and 5.1-fold (2.3-11.1) increases in odds of dying as compared with no complication. CONCLUSIONS: First complications after surgery, even seemingly mild ones, may radically alter the patient's risk of death. First complications often begin the cascade of complications that end in death. Caregivers should consider the first complication as a timely signal of a changed clinical situation demanding a reevaluation of the patient's care. Researchers may use these estimates to determine the relative severity of a broad range of first or early complications.

Aged↗

PubMed2005

Preoperative antibiotics and mortality in the elderly.

OBJECTIVE AND BACKGROUND: It is generally thought that the use of preoperative antibiotics reduces the risk of postoperative infection, yet few studies have described the association between preoperative antibiotics and the risk of dying. The objective of this study was to determine whether preoperative antibiotics are associated with a reduced risk of death. METHODS: We performed a multivariate matched, population-based, case-control study of death following surgery on 1362 Pennsylvania Medicare patients between 65 and 85 years of age undergoing general and orthopedic surgery. Cases (681 deaths within 60 days from hospital admission) were randomly selected throughout Pennsylvania using claims from 1995 and 1996. Models were developed to scan Medicare claims, looking for controls who did not die and who were the closest matches to the previously selected cases based on preoperative characteristics. Cases and their controls were identified, and charts were abstracted to define antibiotic use and obtain baseline severity adjustment data. RESULTS: For general surgery, the odds of dying within 60 days were less than half in those treated with preoperative antibiotics within 2 hours of incision as compared with those without such treatment: (odds ratio = 0.44; 95% confidence interval, 0.32-0.60), P < 0.0001). For orthopedic surgery, no significant mortality reduction was observed (OR = 0.85; 95% confidence interval, 0.54-1.32; P < 0.464). INTERPRETATION: Preoperative antibiotics are associated with a substantially lower 60-day mortality rate in elderly patients undergoing general surgery. In patients who appear to be comparable, the risk of death was half as large among those who received preoperative antibiotics.

Age Factors↗

PubMed2004

Morbidity and mortality of colorectal carcinoma surgery differs by insurance status.

BACKGROUND: Uninsured and underinsured patients are reported to be at an increased risk for impaired access to healthcare, delayed medical treatment, and the receipt of substandard care. These differences in care may result in disparities in surgical outcomes among patients with different types of insurance. In the current study, the authors examined associations between the insurance provider and short-term surgical outcomes after surgery for colorectal carcinoma and evaluated the extent to which two risk factors (comorbid disease and admission type) might explain any observed association. METHODS: The authors conducted a nationally representative retrospective cohort study of 13,415 adults ages 40-64 years who were admitted for surgery for colorectal carcinoma to hospitals that participated in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project National Inpatient Sample, releases 6 and 7, in 1997 and 1998. Multivariate logistic regression models were developed to describe the correlations between insurance status and the risks of a postoperative complication or postoperative death after adjustment for socioeconomic factors, comorbid conditions, and admission type. RESULTS: Uninsured and Medicaid patients were found to have more emergent admissions and more comorbid disease compared with patients with private health insurance. Patients without private health insurance had higher rates of postoperative complications and in-hospital death compared with those patients with private insurance. After adjusting for patient and hospital characteristics, patients with Medicaid were found to be 22% more likely to develop a complication during their hospital admission (odds ratio [OR] of 1.22; 95% confidence interval [95%CI], 1.06-1.40) and 57% more likely to die postoperatively (OR of 1.57; 95% CI, 1.01-2.42) compared with patients with private insurance. CONCLUSIONS: The current study findings suggest that the uninsured and Medicaid populations are at greater risk of developing postoperative complications and dying than the privately insured population due only in part to preexisting medical comorbidities and emergent admission type.

Adult↗