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Results for “Hospital Mortality”

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At least 19 recordsLinked to original sources

PubMed2026

Association of time-averaged systemic immune-inflammation indices with in-hospital mortality after intracerebral hemorrhage: a retrospective study.

BACKGROUND: Systemic inflammation plays a central role in secondary brain injury following intracerebral hemorrhage (ICH). Although inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) are linked to poor outcomes, their associations with mortality are commonly assumed to be linear, potentially overlooking nonlinear patterns where mortality risk rises steeply at higher levels. METHODS: We conducted a retrospective study using the MIMIC-IV database, including 440 patients with non-traumatic ICH who were alive and remained in the ICU for at least 72 h after admission. Mean NLR, SII, and SIRI were calculated from measurements obtained during this period. Multivariable logistic regression and restricted cubic spline (RCS) analyses were applied to assess their independent and nonlinear associations with in-hospital mortality. Model discrimination and calibration were internally validated using 1,000 bootstrap resamples. RESULTS: The in-hospital mortality rate was 26.1%. After multivariable adjustment, NLR and SIRI remained independently associated with mortality. Patients in the highest SIRI quartile had the highest risk of death (aOR = 5.12; 95% CI: 2.57-12.24; p < 0.001). RCS analysis revealed a significant nonlinear association between SIRI and mortality (p-nonlinearity < 0.05), showing a steep risk increase at higher SIRI levels. Adding SIRI to the base model provided a modest improvement in discrimination (AUC 0.762 to 0.785, p = 0.045) and significantly improved risk reclassification (cNRI = 0.4778, p < 0.001; IDI = 0.0240, p = 0.0151). CONCLUSIONS: Among patients with ICH who met the 72-hour eligibility criterion, higher 72-hour average SIRI was independently associated with in-hospital mortality. As a time-averaged measure, SIRI should be interpreted as a dynamic marker integrating the initial inflammatory state and the early clinical course rather than as a purely baseline prognostic factor. Although adding SIRI to the base model modestly improved discrimination and risk reclassification, it should be considered a candidate prognostic marker requiring external validation before clinical application.

Humans↗

PubMed1979

Esophagogastrectomy for carcinoma: current hospital mortality and morbidity rates.

Between January 1, 1970, and March 1, 1979, 153 patients with carcinoma of the esophagus or cardia were seen at the Lahey Clinic; 124 (81%) underwent surgical exploration and 102 (82.3%) were found amendable to resection. This report concerns the 82 patients operated on by the senior author, 72 of whom (87.8%) had surgical resection. A variety of resective techniques were used but currently esophagogastrectomy and esophagogastrostomy is preferred, a left thoracotomy being used for low lying lesions; upper thoracic and cervical lesions are approached through a combined abdominal and right thoracic approach or esophagectomy with cervical esophagogastrostomy and without thoracotomy is used. Two deaths occurred within 30 days of operation, a hospital mortality rate of 2.8%. Significant complications developed in 11 patients (15.3%). The average survival was 20.8 months, and satisfactory long-term relief of dysphagia was achieved in 91.2% of patients. An aggressive surgical approach to the management of patients with carcinoma of the esophagus or cardia is justified, for esophagogastrectomy and esophagogastrostomy is applicable to the majority of patients; can now be performed at low risk with a reasonable period of hospitalization; and provides satisfactory long-term palliation.

Adenocarcinoma↗

PubMed1979

[Analysis of hospital mortality in myocardial infarct].

Explore the source record for details and available documents.

Aged↗

PubMed1977

Surgical experience with postinfarction ventricular aneurysm.

Fifty-eight patients had surgical treatment of postinfarction ventricular aneurysm. Resection was performed in 47 patients and plication in 11. There were 44 combined procedures, mostly myocardial revascularizations. Indications for operation included congestive heart failure, angina, arrhythmias, and thromboembolic phenomena. All aneurysms were documented by cineventriculography, and 54 patients had coronary cineangiograms. Left ventricular end diastolic (LVED) pressures ranged from 25 to 50 in 25 of the patients but did not affect mortality. Hospital mortality (14% overall) was directly proportional to degree of coronary artery disease--single vessel, 0; double vessel, 10%; triple, 24%. Nine patients are alive more than six months postoperatively and 37 are alive from six months to eight years postoperatively. We conclude that aneurysmectomy is the procedure of choice for ventricular aneurysms that are hemodynamically significant or have produced ventricular clots, arrhythmias, or embolic phenomena. An LVED of greater than 25 mm Hg does not contraindicate operation, but triple vessel coronary disease increases the risk.

Adult↗

PubMed1978

Abdominal aortic aneurysms: recent experience with 210 patients.

In the 6 1/2 years ending June 1977, 210 patients with abdominal aortic aneurysms underwent operation at Toronto Western Hospital; 160 aneurysms (76%) were unruptured and 50 (24%) were ruptured. In the patients with unruptured aneurysms the mean age was 68 years; the oldest was 91, and 12 were more than 80 years of age. The overall hospital mortality was 5.6%. Death in hospital occurred in 1 (1.2%) of the 83 asymptomatic patients, 4 (7.4%) of the 54 symptomatic patients and 4 (17.0%) of the 23 patients for whom operation was considered urgent. In the patients with ruptured aneurysms the mean age was 71 years; the oldest was 90, and five were more than 80 years of age. The overall hospital mortality was 54%. The morbidity and mortality were analysed; in particular the reasons for the markedly variable hazard of operations for the three categories of unruptured aneurysm were sought. The surgical literature is confusing because of the interchanging use of the words unruptured, elective and symptomless. The current philosophy management and technique of operation in a large cardiovascular surgery service with many trainees are presented and a plea is made for a standardized and simplified operation, always performed with three assistants helping the operating surgeon.

Aged↗

PubMed1977

Comparison of results from a cardiac ambulance manned by medical or non-medical personnel.

During a 20-month period a "cardiac" ambulance was manned on alternate days by specially-trained ambulance personnel only, or by such personnel plus a doctor. The presence of a doctor did not lead to any reduction in the mortality of patients with heart-attacks. Although transport to hospital by the special service was associated with a low pre-hospital mortality, this was balanced by a high pre-hospital mortality in the group of patients brought to hospital by routine ambulances at times when the special vehicle was manned, but for some reason was not used. There was evidence of unintentional selection of low-risk cases for transport by the cardiac ambulance. The number of lives saved by the special service was too small to cause any significant reduction in the overall mortality from heart-attacks in Nottingham.

Adult↗

PubMed1979

The Celestin tube in the palliation of carcinoma of the oesophagus and cardia.

A series of 105 patients with dysphagia due to inoperable carcinoma of the oesophagus or cardia of the stomach, and 11 patients with dysphagia secondary to malignant medistinal nodes, was treated by intubation with a Celestin tube. The hospital mortality was high but 81 patients left hospital and 29 were still alive at 6 months. The prognosis for those with dysphagia due to malignant posterior mediastinal nodes was very poor, with no survivors at 6 months. Oesophageal perforation was a serious operative complication, with a hospital mortality of 83 per cent. Chest and wound infections were the most common postoperative complications occurring in 28 and 20 per cent of the patients, respectively. The restoration of swallowing was satisfactory in the majority of survivors although readmission with a blocked or displaced tube was not uncommon.

Adult↗

PubMed1979

Mitral valve replacement: a nine-year follow-up of risks and survivals.

Experience with mitral valve replacement over a nine-year period is reviewed. Hospital mortality was 8.9%, with an additional late mortality of 18.5% during a mean follow-up period of 4.34 years. Study of the factors influencing the results of valve replacement revealed a direct correlation between long-term survival and New York Heart Association (NYHA) Functional Class, as judged preoperatively, as well as left ventricular end-diastolic pressure, cardiac index, type of valve lesion, and presence of associated coronary artery disease. Hospital mortality was 32% (p less than 0.01) for those patients in NYHA Functional Class IV before operation, compared with 3% for Class III patients. Untreated concomitant coronary artery disease was associated with a significantly higher perioperative mortality of 28% (p = 0.002) compared with an 8% mortality in patients with coronary artery disease treated by vein bypass at the time of mitral valve replacement. Patients with normal coronary arteries documented angiographically before operation had a 1% hospital mortality. Seventy-two percent of all patients are still alive at a maximum follow-up of nine years. Eighty-three percent of those survivors who were in Functional Class III or IV before operation are now considered to be in Class I or II. We conclude that patients should undergo mitral valve replacement before the development of the advanced functional stage of valve disease. In addition, coronary arteriograms should be performed on all patients who are more than 40 years old at the time of cardiac catheterization, and revascularization considered at the time of mitral valve replacement for those patients with significant coronary disease.

Adolescent↗

PubMed1979

Late results of myocardial revascularization.

Data are presented on 1,400 consecutive patients who had myocardial revascularization at our institution. The patients ranged in age from 33 to 80 years. Coronary bypass was done with an associated noncardiac procedure in 70 patients and with an associated cardiac procedure in 73 patients. The hospital mortality was 2.0%. Left ventricular function was a primary determinant of hospital mortality. With a 98% follow-up, survival was 93.1% at a mean of three years (range, six months to seven years). Ventricular function was the prime determinant of the overall long-term survival. These data indicate that myocardial revascularization, either alone or with an associated cardiac or noncardiac procedure, can be done with a low operative mortality. Because of the excellent five-year survival in our group of patients followed up for this length of time, we believe these data support the hypothesis that myocardial revascularization extends the life expectancy of patients with coronary artery disease.

Adult↗

PubMed2024

The association between neighbourhood marginalization and SARS-CoV-2 outcomes in patients presenting to emergency departments.

OBJECTIVE: Social and economic marginalizations have been associated with inferior health outcomes in Canada. Our objective was to describe the relationship between neighbourhood marginalization and COVID-19 outcomes among patients presenting to Canadian emergency departments (ED). METHODS: We conducted an observational study among consecutive COVID-19 patients recruited from 47 hospitals participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 3, 2020, and July 24, 2022. We linked data with the Canadian Marginalization Index (CAN-Marg). We used multivariable, multi-level logistic regression models to understand the association between dimensions of neighbourhood marginalization, and severe COVID-19 and in-hospital mortality. RESULTS: There were 55,588 eligible patients. Those from neighbourhoods with a higher proportion of recent immigrants (OR = 0.86 per unit increase [0.81, 0.92]), lower workforce participation (OR = 0.84 per unit increase [0.75, 0.94]), and more housing insecurity (OR = 0.81 per unit increase [0.77, 0.86]) were less likely to present to EDs with severe COVID-19. However, patients from materially marginalized neighbourhoods had increased odds of dying in hospital (OR = 1.19 per unit increase [95% CI 1.09, 1.30]) compared to patients from less materially marginalized neighbourhoods. Patients living in neighbourhoods with a higher proportion of recent immigrants (OR = 0.83 per unit increase [0.78, 0.91]) and lower participation in the workforce (OR = 0.77 per unit increase [0.66, 0.87]) experienced lower odds of dying. CONCLUSION: Despite no association with severe COVID-19 at ED presentation, the only marginalization domain associated with in-hospital mortality was material deprivation. Our findings present insights on ED-seeking behaviour, hospital access, and care that population studies could not.

Humans↗

PubMed1978

Concepts and practices in surgery for total anomalous pulmonary venous connection.

In the last ten years there have been extensive refinements in the surgical approach to total anomalous pulmonary venous connection (TAPVC). This communication reviews determinants of hosptal mortality and controversies in surgical management. As examples of current experience with repair of TAPVC, recent results at the University of Alabama and a combined analysis of hospital mortality for Alabama, Children's Hospital Medical Center in Boston, and Green Lane Hospital are reported. From July, 1974, to July 1977, the Alabama hospital mortality among the 17 infants with supracardiac, cardiac, and infracardiac TAPVC was 12% (2 infants).

Cardiomegaly↗

PubMed2026

Respiratory syncytial virus (RSV) in older adults: from infection to outcomes - who gets sick, who gets hospitalized, who survives?

Respiratory syncytial virus (RSV) is a virus responsible for acute respiratory infections and is widely recognized as a major pathogen in the paediatric population. Thus, the burden of RSV in the adult population remains poorly understood, as epidemiological studies mainly rely on PMSI (Medicalization of Information Systems Program) data, which are coded for economic purposes, and because many adults RSV infections remain underdiagnosed. The aim of this study was to describe epidemiological and clinical characteristics of RSV infections in elderly population across four university hospitals in north-western France during the 2022-2023 epidemic season. This retrospective cohort included all patients aged 60 years and older who tested positive for RSV between September 1st, 2022, and January 31st, 2023, in four university hospitals. Viral detection was performed using molecular assays on respiratory samples. Clinical, demographic, biological, and coding data were collected from medical records and hospital information systems. Outcomes included need for oxygen therapy, intensive care admission, in-hospital mortality, length of stay, readmission within 90 days for a respiratory or cardiac reason, and changes in living arrangements. Statistical analyses used descriptive methods and standard tests for comparisons. A total of 647 patients were included. The mean age was 77.8 years, and most patients had at least one chronic medical condition, primarily respiratory or cardiac. 508 (78.5%) patients were hospitalized. The mean hospital stay was 16.2 days, and oxygen therapy was required in 68.3% of cases. In-hospital mortality reached 11.0%. Among survivors, 38.0% were readmitted within 90 days for a respiratory or cardiac reason. A notable proportion of patients experienced a loss of autonomy leading to institutional placement at discharge. RSV was coded in the PMSI database as a diagnosis in approximately two-thirds of hospitalizations, with substantial variations between centers. RSV infection in older adults was associated with significant morbidity, prolonged hospitalization, and a frequent decline in functional status. The study also identified heterogeneity in coding practices and emphasized limitations of PMSI data for capturing respiratory syncytial virus burden. These findings support the need for expanded screening, along with targeted preventive strategies and structured post-discharge follow-up to reduce the long-term burden of RSV in older populations.

Humans↗

PubMed1979

Evaluation of management of the emergency right hemicolectomy.

To evaluate the morbidity and mortality attending emergency resection of the right colon, we studied retrospectively 119 consecutive patients from two major centers, particularly examining the role of delayed anastomosis (initial ileostomy with subsequent ileocolic anastomosis). Emergency right colectomy was defined as an operative procedure in which partial resection of the terminal ileum and total or partial resection of the cecum and/or ascending colon were necessary before the colon could be evacuated and prepared as might be the case in elective resection. Ninety patients underwent primary anastomosis; hospital mortality and morbidity were 26 and 11%, respectively. Among 29 patients who underwent ileostomy, hospital mortality was 38%; hospital morbidity was 10%. In general, the patients selected for ileostomy were somewhat more ill or had more severe injury. only 17% of all deaths and 8% of all serious complications could be attributed to the anastomosis, leaving little statistical opportunity for improvement by deleting it. The data indicate that a very high mortality (29%) attends emergency right hemicolectomy. Our study indicates that ileostomy in lieu of anastomosis does not reduce this high mortality.

Adolescent↗

PubMed2026

Aneurysmal subarachnoid hemorrhage care in a middle-income public healthcare system: A real-world neurocritical care cohort.

BACKGROUND AND PURPOSE: Although aneurysm treatment capacity has expanded worldwide, outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain strongly influenced by neurocritical care (NCC) delivery, referral pathways, and access to specialized treatment. Contemporary data describing real-world aSAH care in resource-limited healthcare systems remain scarce. We aimed to characterize treatment patterns, NCC delivery, complications, and outcomes in a large Brazilian public referral center. METHODS: This retrospective cohort study included consecutive adults with confirmed aSAH admitted between June 2018 and March 2022 to a high-volume Brazilian tertiary referral center. Only patients admitted within five days of symptom onset were included. Demographic, clinical, radiological, treatment, complication, and outcome data were extracted from institutional records. Primary outcomes were in-hospital mortality and 3-month functional outcome assessed by the modified Rankin Scale (mRS). RESULTS: Seventy-four patients were included. Disease severity was high, with 45% presenting WFNS grades 4-5, 73% modified Fisher grade 4 hemorrhage, and 64% hydrocephalus. Endovascular treatment was performed in 73% of cases, and median time from admission to aneurysm treatment was 1 day. Despite early treatment capability, only 28% of patients were admitted to an ICU within 48 h, while 38% never received ICU care. Delayed cerebral ischemia occurred in 43%, radiologic vasospasm in 58%, ventriculitis in 22%, and infectious complications in 57%. External ventricular drainage was required in 42%, and vasoactive drugs were used in 85%. In-hospital mortality was 42%, and 66% had unfavorable 3-month outcomes (mRS 4-6). CONCLUSIONS: This real-world cohort highlights the substantial neurocritical care burden of aSAH in a middle-income public healthcare system. Despite timely access to definitive aneurysm treatment, patients experienced frequent neurological and systemic complications, emphasizing that contemporary aSAH care extends well beyond aneurysm occlusion.

Humans↗

PubMed1979

[Mortality from diabetic coma at the Basle Cantonal Hospital during 2 consecutive observation periods 1968-1973 abd 1973-1978, using conventional insulin therapy and treatment with lose dose insulin].

163 patients were admitted to the Cantonal Hospital, Basel, during the decade 1968--1978 with severe diabetic ketoacidosis or non-ketotic coma. The hospital mortality rate was 28% in the first period (1968--1973) but decreased to 14% (p less than 0.025) in the second period (1973--1978). The lower mortality rate in the second period was due to diminished early mortality within 3 days after admission. The decline in the mortality rate during the second period was assumed to be due to a general improvement of treatment and possibly to a direct effect of low-dose insulin therapy. The latter conclusion followed from the fact that the remaining recompensation therapy, such as fluid and electrolyte replacement, was similar during both periods. However, in the non-ketotic patients low-dose insulin therapy resulted in a delayed fall in blood glucose and distinctly diminished potassium retention. The fatalities in the second period of treatment were mainly due to thromboembolic complications. This points to the need for a search for preventive measures against thromboembolism in order to resuce mortality in severe diabetic coma further.

Blood Glucose↗

PubMed2025

Temporal and geographical lineage dynamics of invasive Streptococcus pyogenes in Australia from 2011 to 2023: a retrospective, multicentre, clinical and genomic epidemiology study.

BACKGROUND: Defining the temporal dynamics of invasive Streptococcus pyogenes (group A Streptococcus) and differences between hyperendemic and lower-incidence regions provides crucial insights into pathogen evolution and, in turn, informs preventive measures. We aimed to examine the clinical and temporal lineage dynamics of S pyogenes across different disease settings in Australia to improve understanding of drivers of pathogen diversity. METHODS: In this retrospective, multicentre, clinical and genomic epidemiology study, we identified cases of invasive S pyogenes infection from normally sterile sites between Jan 1, 2011, and Feb 28, 2023. Data were collected from five hospital networks across low-incidence regions in temperate southeast Australia and the hyperendemic, tropical, and largely remote Top End of the Northern Territory of Australia. The crude incidence rate ratio (IRR) of bloodstream S pyogenes infection comparing the Top End and southeast Australia and in First Nations people compared with non-First Nations people was estimated by quasi-Poisson regression. We estimated odds ratios (ORs) of intensive care unit (ICU) admission, in-hospital mortality, and 30-day mortality for the Top End versus southeast Australia using logistic regression. Retrieved and successfully sequenced isolates were assigned lineages at whole-genome resolution. Temporal trends in the composition of co-circulating lineages were compared between the two regions. We used an S pyogenes-specific multistrain simulated transmission model to examine the relationship between host population-specific parameters and observed pathogen lineage dynamics. The prevalence of accessory genes (those present in 5-95% of all genomes) was compared across geographies and temporal periods to investigate genomic drivers of diversity. FINDINGS: We identified 500 cases of invasive S pyogenes infection in patients in the Top End and 495 cases in patients in southeast Australia. The crude IRR of bloodstream infection for the Top End compared with southeast Australia was 5·97 (95% CI 4·61-7·73) across the entire study period; in the Top End, infection disproportionately affected First Nations people compared with non-First Nations people (5·41, 4·28-6·89). The odds of in-hospital mortality (OR 0·43, 95% CI 0·26-0·70), 30-day mortality (0·38, 0·23-0·63), and ICU admission (0·42, 0·30-0·59) were lower in the Top End than in southeast Australia. Longitudinal lineage analysis of 642 S pyogenes genomes identified waves of replacement with distinct lineages in the Top End, whereas southeast Australia had a small number of dominant lineages that persisted and cycled in frequency. The transmission model qualitatively reproduced a similar pattern of replacement with distinct lineages when using a high transmission rate, small population size, and high levels of human movement-characteristics similar to those of communities in the hyperendemic Top End. Using a lower transmission rate, larger population size, and lower levels of migration similar to those of communities in urbanised southeast Australia, the transmission model qualitatively reproduced a pattern of dominant lineages that cycled in frequency. Despite distinct circulating lineages, the prevalence of accessory genes in the bacterial population was maintained across geographies and temporal periods. INTERPRETATION: In a hyperendemic setting, the replacement of distinct S pyogenes lineages occurred in waves, which could be linked to the disproportionate burden of disease and sparse human population in this setting. The maintenance of bacterial gene frequency could be consistent with multilocus selection. These findings suggest that lineage-specific interventions-such as vaccines under development-should consider disease setting and, without broad cross-protection, might lead to lineage replacement. FUNDING: National Health and Medical Research Council, and Leducq Foundation.

Humans↗

PubMed1978

Coronary artery surgery: indications and recent experience.

The comprehensive experience of coronary artery surgery in a Cardiothoracic Unit over a 31-month period is reviewed. Hospital mortality for elective bypass grafting was 3.9% overall and 2.5% in those with good pre-operative left ventricular function. Major influences on hospital mortality were pre-operative left ventricular function, extent of coronary artery disease and extent of the surgical procedure undertaken in terms of number of aortocoronary grafts inserted, coronary endarterectomy and particularly concomitant valve surgery or aneurysm resection. Follow-up experience shows 74% of grafted patients to be symptom-free and 85% symptomatically improved one year after surgery with 70% symptom-free and 80% improved at two years. Early post-operative deaths appear related to early graft closure and recurrence of symptoms postoperatively to late graft closure or progression of coronary disease in the native circulation. The study provides a guide to the relative risks of coronary artery surgery for symptomatic coronary artery disease and expected symptomatic results in the early follow-up period.

Adult↗

PubMed1979

Bystander-initiated cardiopulmonary resuscitation in the management of ventricular fibrillation.

We assessed the influence of bystander-initiated cardiopulmonary resuscitation upon outcome in 316 consecutive patients treated for out-of-hospital ventricular fibrillation. Of 109 patients who received bystander-initiated cardiopulmonary resuscitation, 47 (43%) were ultimately discharged home. Of 207 patients for whom resuscitation was delayed until arrival of fire department personnel, 43 (21%) survived (P less than 0.001). Improved survival was largely due to a reduction in subsequent hospital mortality rather than to a higher rate of initially effective resuscitation. In a separate analysis of 118 patients treated at a single institution after resuscitation, the reduced hospital mortality reflected a decrease in deaths due to shock and to anoxic encephalopathy. In addition, neurologic dysfunction was significantly less common if bystanders had initiated cardiopulmonary resuscitation. Bystander participation in cardiopulmonary resuscitation represents an important adjunct to a rapid-response emergency care system.

Consciousness↗