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Many May Not Need Vitamin D Supplements
Vitamin D levels above 20 ng/mL were not associated with lower mortality rates in patients with and without kidney disease; however, levels below 12 ng/mL were associated with higher mortality rates in these patients, according to the results of a study published Oct. 24 in the online journal PLoS One.
The minimal difference in mortality rates for individuals with vitamin D levels between 20 ng/mL and 30 ng/mL suggests that vitamin D supplements may not be necessary for approximately 3 million adults with chronic kidney disease and 75 million adults without kidney disease, said Dr. Holly Kramer of Loyola University Medical Center in Maywood, Ill., and her colleagues.
To examine the impact of vitamin D levels on mortality, the researchers reviewed data from 15,099 adults who were part of the Third National Health and Nutrition Examination Study (NHANES III). The study population included 1,097 adults with chronic kidney disease, which was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m2.
In order for mortality rates to be compared, the researchers divided the study population into groups based on vitamin D levels, ranging from less than 12 ng/mL to greater than 40 ng/mL, using the 24- to 29.9-ng/mL group as the reference group.
"This group was selected as the referent, because it includes 25[OH]D levels which are above the threshold for ‘risk of insufficiency,’ defined by the Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, yet below the thresholds defined as ‘insufficient’ in previous analyses," the researchers wrote.
Overall, about one-third of the adults with kidney disease (35%) and of those without kidney disease (30%) had insufficient levels of vitamin D, based on Institute of Medicine recommendations.
The median vitamin D levels for each of the groups were 10.0 ng/mL, 14.1 ng/mL, 18.0 ng/mL, 21.9 ng/mL, 26.5 ng/mL, 33.9 ng/mL, and 43.6 ng/mL.
After the investigators controlled for risk factors including age, race, sex, smoking status, and comorbid conditions, the all-cause mortality rate was determined for the patients with kidney disease. The mortality rate was 153/1,000 person-years for those with vitamin D levels less than 12 ng/mL, 121/1,000 person-years for those in the 12- to 16-ng/mL group, and 108/1,000 person years for those in the 24- to 29.9-ng/mL range.
Mortality rates were similar for those with kidney disease and vitamin D levels greater than 20 ng/mL, the researchers noted, with the lowest mortality rate of 97/1,000 person-years seen in those in the highest vitamin D group.
Among patients without kidney disease, the adjusted all-cause mortality rate was 17/1,000 person-years among those with vitamin D levels less than 12 ng/mL, compared with 13 for those in the 24- to 29.9-ng/mL range and 12 among patients with vitamin D levels greater than 40 ng/mL.
The study was limited by its observational design, and the results may not be generalizable to nursing home residents, individuals on dialysis, or anyone who has had a kidney transplant, the researchers noted.
Vitamin D supplementation has been linked to an increased risk of cancer and kidney stones, and clinical trials are needed to assess the risks versus benefits in individuals with and without kidney disease, the researchers added.
The National Institutes of Health supported the study.
Vitamin D levels above 20 ng/mL were not associated with lower mortality rates in patients with and without kidney disease; however, levels below 12 ng/mL were associated with higher mortality rates in these patients, according to the results of a study published Oct. 24 in the online journal PLoS One.
The minimal difference in mortality rates for individuals with vitamin D levels between 20 ng/mL and 30 ng/mL suggests that vitamin D supplements may not be necessary for approximately 3 million adults with chronic kidney disease and 75 million adults without kidney disease, said Dr. Holly Kramer of Loyola University Medical Center in Maywood, Ill., and her colleagues.
To examine the impact of vitamin D levels on mortality, the researchers reviewed data from 15,099 adults who were part of the Third National Health and Nutrition Examination Study (NHANES III). The study population included 1,097 adults with chronic kidney disease, which was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m2.
In order for mortality rates to be compared, the researchers divided the study population into groups based on vitamin D levels, ranging from less than 12 ng/mL to greater than 40 ng/mL, using the 24- to 29.9-ng/mL group as the reference group.
"This group was selected as the referent, because it includes 25[OH]D levels which are above the threshold for ‘risk of insufficiency,’ defined by the Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, yet below the thresholds defined as ‘insufficient’ in previous analyses," the researchers wrote.
Overall, about one-third of the adults with kidney disease (35%) and of those without kidney disease (30%) had insufficient levels of vitamin D, based on Institute of Medicine recommendations.
The median vitamin D levels for each of the groups were 10.0 ng/mL, 14.1 ng/mL, 18.0 ng/mL, 21.9 ng/mL, 26.5 ng/mL, 33.9 ng/mL, and 43.6 ng/mL.
After the investigators controlled for risk factors including age, race, sex, smoking status, and comorbid conditions, the all-cause mortality rate was determined for the patients with kidney disease. The mortality rate was 153/1,000 person-years for those with vitamin D levels less than 12 ng/mL, 121/1,000 person-years for those in the 12- to 16-ng/mL group, and 108/1,000 person years for those in the 24- to 29.9-ng/mL range.
Mortality rates were similar for those with kidney disease and vitamin D levels greater than 20 ng/mL, the researchers noted, with the lowest mortality rate of 97/1,000 person-years seen in those in the highest vitamin D group.
Among patients without kidney disease, the adjusted all-cause mortality rate was 17/1,000 person-years among those with vitamin D levels less than 12 ng/mL, compared with 13 for those in the 24- to 29.9-ng/mL range and 12 among patients with vitamin D levels greater than 40 ng/mL.
The study was limited by its observational design, and the results may not be generalizable to nursing home residents, individuals on dialysis, or anyone who has had a kidney transplant, the researchers noted.
Vitamin D supplementation has been linked to an increased risk of cancer and kidney stones, and clinical trials are needed to assess the risks versus benefits in individuals with and without kidney disease, the researchers added.
The National Institutes of Health supported the study.
Vitamin D levels above 20 ng/mL were not associated with lower mortality rates in patients with and without kidney disease; however, levels below 12 ng/mL were associated with higher mortality rates in these patients, according to the results of a study published Oct. 24 in the online journal PLoS One.
The minimal difference in mortality rates for individuals with vitamin D levels between 20 ng/mL and 30 ng/mL suggests that vitamin D supplements may not be necessary for approximately 3 million adults with chronic kidney disease and 75 million adults without kidney disease, said Dr. Holly Kramer of Loyola University Medical Center in Maywood, Ill., and her colleagues.
To examine the impact of vitamin D levels on mortality, the researchers reviewed data from 15,099 adults who were part of the Third National Health and Nutrition Examination Study (NHANES III). The study population included 1,097 adults with chronic kidney disease, which was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m2.
In order for mortality rates to be compared, the researchers divided the study population into groups based on vitamin D levels, ranging from less than 12 ng/mL to greater than 40 ng/mL, using the 24- to 29.9-ng/mL group as the reference group.
"This group was selected as the referent, because it includes 25[OH]D levels which are above the threshold for ‘risk of insufficiency,’ defined by the Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, yet below the thresholds defined as ‘insufficient’ in previous analyses," the researchers wrote.
Overall, about one-third of the adults with kidney disease (35%) and of those without kidney disease (30%) had insufficient levels of vitamin D, based on Institute of Medicine recommendations.
The median vitamin D levels for each of the groups were 10.0 ng/mL, 14.1 ng/mL, 18.0 ng/mL, 21.9 ng/mL, 26.5 ng/mL, 33.9 ng/mL, and 43.6 ng/mL.
After the investigators controlled for risk factors including age, race, sex, smoking status, and comorbid conditions, the all-cause mortality rate was determined for the patients with kidney disease. The mortality rate was 153/1,000 person-years for those with vitamin D levels less than 12 ng/mL, 121/1,000 person-years for those in the 12- to 16-ng/mL group, and 108/1,000 person years for those in the 24- to 29.9-ng/mL range.
Mortality rates were similar for those with kidney disease and vitamin D levels greater than 20 ng/mL, the researchers noted, with the lowest mortality rate of 97/1,000 person-years seen in those in the highest vitamin D group.
Among patients without kidney disease, the adjusted all-cause mortality rate was 17/1,000 person-years among those with vitamin D levels less than 12 ng/mL, compared with 13 for those in the 24- to 29.9-ng/mL range and 12 among patients with vitamin D levels greater than 40 ng/mL.
The study was limited by its observational design, and the results may not be generalizable to nursing home residents, individuals on dialysis, or anyone who has had a kidney transplant, the researchers noted.
Vitamin D supplementation has been linked to an increased risk of cancer and kidney stones, and clinical trials are needed to assess the risks versus benefits in individuals with and without kidney disease, the researchers added.
The National Institutes of Health supported the study.
FROM PLoS ONE
Diabetes Deaths Decline in Tots and Teens
The overall death rate from diabetes in children aged 19 years and younger dropped by 61% from 1968 to 2009, according to data from the National Vital Statistics System. The findings were published online Nov. 1 in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The overall death rate decrease was 78% in children younger than 10 years and 52% in those aged 10-19 years. A steady decrease occurred in children younger than 10 years from 1968 to 1995 (annual percentage change [APC] of 5.7), with a slightly slower decline from 1995 to 2009 (APC, 0.3). However, the decrease in death rates in youth aged 10-19 years from 1968 to 1984 (APC, of 6.5) was followed by an increase between 1984 and 2009 (APC, 1.6).
"The prevalence of diabetes among youths is determined by a number of factors, including the incidence of new cases and the number of deaths among youth with diabetes," the researchers noted.
"The findings in this report that the overall death rate from diabetes has decreased among U.S. youths aged 19 years and younger might contribute to an overall increase in prevalence of diabetes among youths," they said.
Most diabetes deaths in children and teens are due to acute complications including ketoacidosis and hypoglycemia, and these conditions are preventable, the researchers said. Possible reasons for the decline in diabetes deaths include improvements in treatment, increased identification of diabetes symptoms, and better education about managing diabetes and its complications, they added.
Diabetes-related mortality was determined using data from death certificates filed in all 50 states and the District of Columbia. U.S. census data were used as denominators (MMWR 2012;61:869-72).
The study findings were limited by the lack of distinction between type 1 and type 2 diabetes in the ICD-8 or ICD-9 mortality codes reviewed, and by the lack of analysis based on race or geographic region, the researchers said.
Despite the improvement in mortality rates, "deaths resulting from diabetes in youths potentially are preventable, and these findings indicated a need for improved diabetes diagnosis and care, especially among youths aged 10-19 years, whose risk for diabetes-related mortality appears to have increased in recent years," they said.
The researchers had no financial conflicts to disclose.
The overall death rate from diabetes in children aged 19 years and younger dropped by 61% from 1968 to 2009, according to data from the National Vital Statistics System. The findings were published online Nov. 1 in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The overall death rate decrease was 78% in children younger than 10 years and 52% in those aged 10-19 years. A steady decrease occurred in children younger than 10 years from 1968 to 1995 (annual percentage change [APC] of 5.7), with a slightly slower decline from 1995 to 2009 (APC, 0.3). However, the decrease in death rates in youth aged 10-19 years from 1968 to 1984 (APC, of 6.5) was followed by an increase between 1984 and 2009 (APC, 1.6).
"The prevalence of diabetes among youths is determined by a number of factors, including the incidence of new cases and the number of deaths among youth with diabetes," the researchers noted.
"The findings in this report that the overall death rate from diabetes has decreased among U.S. youths aged 19 years and younger might contribute to an overall increase in prevalence of diabetes among youths," they said.
Most diabetes deaths in children and teens are due to acute complications including ketoacidosis and hypoglycemia, and these conditions are preventable, the researchers said. Possible reasons for the decline in diabetes deaths include improvements in treatment, increased identification of diabetes symptoms, and better education about managing diabetes and its complications, they added.
Diabetes-related mortality was determined using data from death certificates filed in all 50 states and the District of Columbia. U.S. census data were used as denominators (MMWR 2012;61:869-72).
The study findings were limited by the lack of distinction between type 1 and type 2 diabetes in the ICD-8 or ICD-9 mortality codes reviewed, and by the lack of analysis based on race or geographic region, the researchers said.
Despite the improvement in mortality rates, "deaths resulting from diabetes in youths potentially are preventable, and these findings indicated a need for improved diabetes diagnosis and care, especially among youths aged 10-19 years, whose risk for diabetes-related mortality appears to have increased in recent years," they said.
The researchers had no financial conflicts to disclose.
The overall death rate from diabetes in children aged 19 years and younger dropped by 61% from 1968 to 2009, according to data from the National Vital Statistics System. The findings were published online Nov. 1 in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The overall death rate decrease was 78% in children younger than 10 years and 52% in those aged 10-19 years. A steady decrease occurred in children younger than 10 years from 1968 to 1995 (annual percentage change [APC] of 5.7), with a slightly slower decline from 1995 to 2009 (APC, 0.3). However, the decrease in death rates in youth aged 10-19 years from 1968 to 1984 (APC, of 6.5) was followed by an increase between 1984 and 2009 (APC, 1.6).
"The prevalence of diabetes among youths is determined by a number of factors, including the incidence of new cases and the number of deaths among youth with diabetes," the researchers noted.
"The findings in this report that the overall death rate from diabetes has decreased among U.S. youths aged 19 years and younger might contribute to an overall increase in prevalence of diabetes among youths," they said.
Most diabetes deaths in children and teens are due to acute complications including ketoacidosis and hypoglycemia, and these conditions are preventable, the researchers said. Possible reasons for the decline in diabetes deaths include improvements in treatment, increased identification of diabetes symptoms, and better education about managing diabetes and its complications, they added.
Diabetes-related mortality was determined using data from death certificates filed in all 50 states and the District of Columbia. U.S. census data were used as denominators (MMWR 2012;61:869-72).
The study findings were limited by the lack of distinction between type 1 and type 2 diabetes in the ICD-8 or ICD-9 mortality codes reviewed, and by the lack of analysis based on race or geographic region, the researchers said.
Despite the improvement in mortality rates, "deaths resulting from diabetes in youths potentially are preventable, and these findings indicated a need for improved diabetes diagnosis and care, especially among youths aged 10-19 years, whose risk for diabetes-related mortality appears to have increased in recent years," they said.
The researchers had no financial conflicts to disclose.
FROM MORBIDITY AND MORTALITY WEEKLY REPORT
Major Finding: Deaths among children and teens aged 19 years and younger with diabetes dropped from 2.69 per million in 1968-1969 to 1.05 per million in 2008-2009.
Data Source: The data come from death certificates filed in all 50 states and the District of Columbia. U.S. census data were used as denominators.
Disclosures: The researchers had no financial conflicts to disclose.
Hospital Complexity Mitigates Mortality
CHICAGO – Surgical patients receiving care at the least complex hospitals had a 50% increased risk of death compared with those treated at more complex hospitals, based on data from more than 400,000 patients.
Data from previous research suggest that the characteristics of individual hospitals predict surgical outcomes, but the relationship between hospital complexity and surgical mortality has not been well studied, Dr. Marta McCrum said at the annual clinical congress of the American College of Surgeons.
She and her colleagues reviewed Medicare administrative claims data from 2008-2009 and information on hospital characteristics from the American Hospital Association Survey 2009 on 2,695 hospitals. The hospitals were divided into quintiles based on complexity, which for purposes of this study was defined as the number of unique diagnoses and procedures performed at each facility.
"Our research suggests that outcomes for certain surgical procedures are better at more complex hospitals."
"Hospitals that see a wide variety of conditions (common problems but also very rare or complicated diagnoses) would be equipped with the wide range of services and resources needed to support them – that is, they would be complex. Similarly, hospitals that perform the widest range of unique procedures would also have the greatest diversity of services and technology," Dr. McCrum of Harvard University, Boston, explained in an interview.
"We therefore ranked the hospitals separately based on the number of unique diagnoses and procedures they saw, and then summed the ranks to assign a numeric value to the complexity of that hospital in comparison to the others. For the analysis, we separated the hospitals into quintiles based on this value."
Not surprisingly, low-complexity hospitals tended to be smaller, more rural, and located in lower-income areas, and the more complex hospitals tended to be larger, urban, and in higher-income areas, she said.
"Of note, the surgical mortality rate of the highest-complexity hospitals was 7.3%, versus 12.6% at the lowest-complexity hospitals," for an absolute risk reduction of 5.3%, she said.
The researchers controlled for hospital and population characteristics, including total number of hospital discharges, public/private ownership, percentage of Medicare patients, urban location, and county income. Hospital complexity remained a significant predictor of mortality between each quintile compared with the highest-complexity quintile.
"The average aggregate mortality rate at the lowest-complexity hospitals is 46% higher than that of the highest-complexity hospitals," said Dr. McCrum.
Overall, the research model explained 28% of the variability in mortality rates, and within the model, hospital complexity explained the greatest proportion of variability in mortality rates. Although hospital volume was a statistically significant predictor of mortality, the effect was small, she noted.
The study was limited by the fact that approximately two-thirds of the variability remained unexplained, likely due to a combination of patient factors and hospital factors, she said. Additional limitations included the lack of an existing metric to measure hospital complexity, and the limitations of using administrative claims data.
"Our research suggests that outcomes for certain surgical procedures are better at more complex hospitals," Dr. McCrum said in an interview. "This might be due in part to the expanded capabilities and systems of care present at these centers. By identifying these lifesaving elements that are cultivated in complex centers, and making them available in lower-complexity hospitals, we can ensure that all surgical procedures take place in facilities with the appropriate systems to support them," she said.
Dr. McCrum had no financial conflicts to disclose.
CHICAGO – Surgical patients receiving care at the least complex hospitals had a 50% increased risk of death compared with those treated at more complex hospitals, based on data from more than 400,000 patients.
Data from previous research suggest that the characteristics of individual hospitals predict surgical outcomes, but the relationship between hospital complexity and surgical mortality has not been well studied, Dr. Marta McCrum said at the annual clinical congress of the American College of Surgeons.
She and her colleagues reviewed Medicare administrative claims data from 2008-2009 and information on hospital characteristics from the American Hospital Association Survey 2009 on 2,695 hospitals. The hospitals were divided into quintiles based on complexity, which for purposes of this study was defined as the number of unique diagnoses and procedures performed at each facility.
"Our research suggests that outcomes for certain surgical procedures are better at more complex hospitals."
"Hospitals that see a wide variety of conditions (common problems but also very rare or complicated diagnoses) would be equipped with the wide range of services and resources needed to support them – that is, they would be complex. Similarly, hospitals that perform the widest range of unique procedures would also have the greatest diversity of services and technology," Dr. McCrum of Harvard University, Boston, explained in an interview.
"We therefore ranked the hospitals separately based on the number of unique diagnoses and procedures they saw, and then summed the ranks to assign a numeric value to the complexity of that hospital in comparison to the others. For the analysis, we separated the hospitals into quintiles based on this value."
Not surprisingly, low-complexity hospitals tended to be smaller, more rural, and located in lower-income areas, and the more complex hospitals tended to be larger, urban, and in higher-income areas, she said.
"Of note, the surgical mortality rate of the highest-complexity hospitals was 7.3%, versus 12.6% at the lowest-complexity hospitals," for an absolute risk reduction of 5.3%, she said.
The researchers controlled for hospital and population characteristics, including total number of hospital discharges, public/private ownership, percentage of Medicare patients, urban location, and county income. Hospital complexity remained a significant predictor of mortality between each quintile compared with the highest-complexity quintile.
"The average aggregate mortality rate at the lowest-complexity hospitals is 46% higher than that of the highest-complexity hospitals," said Dr. McCrum.
Overall, the research model explained 28% of the variability in mortality rates, and within the model, hospital complexity explained the greatest proportion of variability in mortality rates. Although hospital volume was a statistically significant predictor of mortality, the effect was small, she noted.
The study was limited by the fact that approximately two-thirds of the variability remained unexplained, likely due to a combination of patient factors and hospital factors, she said. Additional limitations included the lack of an existing metric to measure hospital complexity, and the limitations of using administrative claims data.
"Our research suggests that outcomes for certain surgical procedures are better at more complex hospitals," Dr. McCrum said in an interview. "This might be due in part to the expanded capabilities and systems of care present at these centers. By identifying these lifesaving elements that are cultivated in complex centers, and making them available in lower-complexity hospitals, we can ensure that all surgical procedures take place in facilities with the appropriate systems to support them," she said.
Dr. McCrum had no financial conflicts to disclose.
CHICAGO – Surgical patients receiving care at the least complex hospitals had a 50% increased risk of death compared with those treated at more complex hospitals, based on data from more than 400,000 patients.
Data from previous research suggest that the characteristics of individual hospitals predict surgical outcomes, but the relationship between hospital complexity and surgical mortality has not been well studied, Dr. Marta McCrum said at the annual clinical congress of the American College of Surgeons.
She and her colleagues reviewed Medicare administrative claims data from 2008-2009 and information on hospital characteristics from the American Hospital Association Survey 2009 on 2,695 hospitals. The hospitals were divided into quintiles based on complexity, which for purposes of this study was defined as the number of unique diagnoses and procedures performed at each facility.
"Our research suggests that outcomes for certain surgical procedures are better at more complex hospitals."
"Hospitals that see a wide variety of conditions (common problems but also very rare or complicated diagnoses) would be equipped with the wide range of services and resources needed to support them – that is, they would be complex. Similarly, hospitals that perform the widest range of unique procedures would also have the greatest diversity of services and technology," Dr. McCrum of Harvard University, Boston, explained in an interview.
"We therefore ranked the hospitals separately based on the number of unique diagnoses and procedures they saw, and then summed the ranks to assign a numeric value to the complexity of that hospital in comparison to the others. For the analysis, we separated the hospitals into quintiles based on this value."
Not surprisingly, low-complexity hospitals tended to be smaller, more rural, and located in lower-income areas, and the more complex hospitals tended to be larger, urban, and in higher-income areas, she said.
"Of note, the surgical mortality rate of the highest-complexity hospitals was 7.3%, versus 12.6% at the lowest-complexity hospitals," for an absolute risk reduction of 5.3%, she said.
The researchers controlled for hospital and population characteristics, including total number of hospital discharges, public/private ownership, percentage of Medicare patients, urban location, and county income. Hospital complexity remained a significant predictor of mortality between each quintile compared with the highest-complexity quintile.
"The average aggregate mortality rate at the lowest-complexity hospitals is 46% higher than that of the highest-complexity hospitals," said Dr. McCrum.
Overall, the research model explained 28% of the variability in mortality rates, and within the model, hospital complexity explained the greatest proportion of variability in mortality rates. Although hospital volume was a statistically significant predictor of mortality, the effect was small, she noted.
The study was limited by the fact that approximately two-thirds of the variability remained unexplained, likely due to a combination of patient factors and hospital factors, she said. Additional limitations included the lack of an existing metric to measure hospital complexity, and the limitations of using administrative claims data.
"Our research suggests that outcomes for certain surgical procedures are better at more complex hospitals," Dr. McCrum said in an interview. "This might be due in part to the expanded capabilities and systems of care present at these centers. By identifying these lifesaving elements that are cultivated in complex centers, and making them available in lower-complexity hospitals, we can ensure that all surgical procedures take place in facilities with the appropriate systems to support them," she said.
Dr. McCrum had no financial conflicts to disclose.
FROM THE ANNUAL CLINICAL CONGRESS OF THE AMERICAN COLLEGE OF SURGEONS
Major Finding: Hospitals in the highest quintile of complexity were associated with a 5% absolute risk reduction in surgical mortality rates compared with hospitals in the lowest quintile of complexity.
Data Source: The data come from a review of Medicare administrative claims data from 2008-2009 and information from the American Hospital Association Survey 2009 on 2,695 U.S. hospitals.
Disclosures: Dr. McCrum had no financial conflicts to disclose.
Evidence Mounts for Aspirin's Anticancer Attributes
Adults who take aspirin daily have a 15% reduced risk of death from cancer compared with controls, and a 37% reduced risk of cancer death after 5 years, based on data from 51 randomized trials of daily aspirin use vs. no aspirin.
Findings from previous studies have suggested a cancer-prevention role for aspirin, but long-term data were limited and incomplete, said Dr. Peter Rothwell of the University of Oxford (England), and his colleagues.
The researchers reviewed data from the Antithrombotic Trialists’ Collaboration, PubMed, and Embase. They included only trials of daily aspirin vs. no aspirin.
Overall, randomization to aspirin significantly reduced the risk of nonvascular death in patients in the 51 trials compared with no aspirin (1,021 vs. 1,173, respectively, P = .003).
In a review of cancer deaths from 34 of the 51 studies, aspirin was associated with significantly fewer cancer deaths compared with controls (562 vs. 664, P = .008). The benefit was most evident in patients in trials lasting 5 years or longer, the researchers said (Lancet 2012;379:1602-12).
In terms of primary prevention, daily aspirin use significantly reduced the risk of a composite outcome of major vascular events, cancer, or fatal extracranial bleeds (P = .0002), the researchers noted.
The findings were limited by the focus only on daily aspirin use, and by the use of composite outcomes, the researchers said.
However, the results suggest that aspirin reduces cancer incidence and mortality, they noted.
"In view of the very low rates of vascular events in recent and ongoing trials of aspirin in primary prevention, prevention of cancer could become the main justification for aspirin use in this setting, although more research is required to identify which individuals are likely to benefit most," they said.
The study should be considered in the context of two additional studies by Dr. Rothwell and his colleagues, one published online in the Lancet, and the other published online in the Lancet Oncology, the researchers added.
In the additional Lancet study, a review of five large, randomized trials of daily aspirin of at least 75 mg versus controls, daily aspirin significantly reduced the risk of cancer metastases by 30%-40% in the short term.
These findings may explain the early reduction in cancer risk associated with aspirin that was observed in the primary prevention trials, and the results "are likely to underestimate the true effects of aspirin," the researchers noted (Lancet 2012 [doi: 10.1016/S0140-6736(12)60209-8]).
In the Lancet Oncology, a review of case-control studies, cohort studies, and randomized trials of aspirin use showed significant reductions in the risk of colo- rectal cancer, as well as significant reductions in the risk of esophageal, gastric, biliary, and breast cancer. The greatest impact was on the reduction in risk of gastrointestinal cancers (Lancet Oncol. 2012 [doi: 10.1016/S1470-2045(12)70112-2]).
Both of these additional studies support the role of aspirin in reducing cancer deaths.
The studies were independent of company funding. Dr. Rothwell has received honoraria for talks, advisory board participation, and clinical trial committee participation from multiple companies, including AstraZeneca, Bayer, Boehringer Ingelheim, Sanofi-Aventis/Bristol-Myers Squibb, and Servier, and is on the executive committee of the ARRIVE trial.
Adults who take aspirin daily have a 15% reduced risk of death from cancer compared with controls, and a 37% reduced risk of cancer death after 5 years, based on data from 51 randomized trials of daily aspirin use vs. no aspirin.
Findings from previous studies have suggested a cancer-prevention role for aspirin, but long-term data were limited and incomplete, said Dr. Peter Rothwell of the University of Oxford (England), and his colleagues.
The researchers reviewed data from the Antithrombotic Trialists’ Collaboration, PubMed, and Embase. They included only trials of daily aspirin vs. no aspirin.
Overall, randomization to aspirin significantly reduced the risk of nonvascular death in patients in the 51 trials compared with no aspirin (1,021 vs. 1,173, respectively, P = .003).
In a review of cancer deaths from 34 of the 51 studies, aspirin was associated with significantly fewer cancer deaths compared with controls (562 vs. 664, P = .008). The benefit was most evident in patients in trials lasting 5 years or longer, the researchers said (Lancet 2012;379:1602-12).
In terms of primary prevention, daily aspirin use significantly reduced the risk of a composite outcome of major vascular events, cancer, or fatal extracranial bleeds (P = .0002), the researchers noted.
The findings were limited by the focus only on daily aspirin use, and by the use of composite outcomes, the researchers said.
However, the results suggest that aspirin reduces cancer incidence and mortality, they noted.
"In view of the very low rates of vascular events in recent and ongoing trials of aspirin in primary prevention, prevention of cancer could become the main justification for aspirin use in this setting, although more research is required to identify which individuals are likely to benefit most," they said.
The study should be considered in the context of two additional studies by Dr. Rothwell and his colleagues, one published online in the Lancet, and the other published online in the Lancet Oncology, the researchers added.
In the additional Lancet study, a review of five large, randomized trials of daily aspirin of at least 75 mg versus controls, daily aspirin significantly reduced the risk of cancer metastases by 30%-40% in the short term.
These findings may explain the early reduction in cancer risk associated with aspirin that was observed in the primary prevention trials, and the results "are likely to underestimate the true effects of aspirin," the researchers noted (Lancet 2012 [doi: 10.1016/S0140-6736(12)60209-8]).
In the Lancet Oncology, a review of case-control studies, cohort studies, and randomized trials of aspirin use showed significant reductions in the risk of colo- rectal cancer, as well as significant reductions in the risk of esophageal, gastric, biliary, and breast cancer. The greatest impact was on the reduction in risk of gastrointestinal cancers (Lancet Oncol. 2012 [doi: 10.1016/S1470-2045(12)70112-2]).
Both of these additional studies support the role of aspirin in reducing cancer deaths.
The studies were independent of company funding. Dr. Rothwell has received honoraria for talks, advisory board participation, and clinical trial committee participation from multiple companies, including AstraZeneca, Bayer, Boehringer Ingelheim, Sanofi-Aventis/Bristol-Myers Squibb, and Servier, and is on the executive committee of the ARRIVE trial.
Adults who take aspirin daily have a 15% reduced risk of death from cancer compared with controls, and a 37% reduced risk of cancer death after 5 years, based on data from 51 randomized trials of daily aspirin use vs. no aspirin.
Findings from previous studies have suggested a cancer-prevention role for aspirin, but long-term data were limited and incomplete, said Dr. Peter Rothwell of the University of Oxford (England), and his colleagues.
The researchers reviewed data from the Antithrombotic Trialists’ Collaboration, PubMed, and Embase. They included only trials of daily aspirin vs. no aspirin.
Overall, randomization to aspirin significantly reduced the risk of nonvascular death in patients in the 51 trials compared with no aspirin (1,021 vs. 1,173, respectively, P = .003).
In a review of cancer deaths from 34 of the 51 studies, aspirin was associated with significantly fewer cancer deaths compared with controls (562 vs. 664, P = .008). The benefit was most evident in patients in trials lasting 5 years or longer, the researchers said (Lancet 2012;379:1602-12).
In terms of primary prevention, daily aspirin use significantly reduced the risk of a composite outcome of major vascular events, cancer, or fatal extracranial bleeds (P = .0002), the researchers noted.
The findings were limited by the focus only on daily aspirin use, and by the use of composite outcomes, the researchers said.
However, the results suggest that aspirin reduces cancer incidence and mortality, they noted.
"In view of the very low rates of vascular events in recent and ongoing trials of aspirin in primary prevention, prevention of cancer could become the main justification for aspirin use in this setting, although more research is required to identify which individuals are likely to benefit most," they said.
The study should be considered in the context of two additional studies by Dr. Rothwell and his colleagues, one published online in the Lancet, and the other published online in the Lancet Oncology, the researchers added.
In the additional Lancet study, a review of five large, randomized trials of daily aspirin of at least 75 mg versus controls, daily aspirin significantly reduced the risk of cancer metastases by 30%-40% in the short term.
These findings may explain the early reduction in cancer risk associated with aspirin that was observed in the primary prevention trials, and the results "are likely to underestimate the true effects of aspirin," the researchers noted (Lancet 2012 [doi: 10.1016/S0140-6736(12)60209-8]).
In the Lancet Oncology, a review of case-control studies, cohort studies, and randomized trials of aspirin use showed significant reductions in the risk of colo- rectal cancer, as well as significant reductions in the risk of esophageal, gastric, biliary, and breast cancer. The greatest impact was on the reduction in risk of gastrointestinal cancers (Lancet Oncol. 2012 [doi: 10.1016/S1470-2045(12)70112-2]).
Both of these additional studies support the role of aspirin in reducing cancer deaths.
The studies were independent of company funding. Dr. Rothwell has received honoraria for talks, advisory board participation, and clinical trial committee participation from multiple companies, including AstraZeneca, Bayer, Boehringer Ingelheim, Sanofi-Aventis/Bristol-Myers Squibb, and Servier, and is on the executive committee of the ARRIVE trial.
Major Finding: In a review of data from 51 studies, daily aspirin use reduced cancer deaths by 15% compared with no daily aspirin use, and reduced the risk of cancer deaths by 37% for those taking aspirin for 5 years or more.
Data Source: The data come from a review of 51 randomized trials of adults taking aspirin vs. controls to prevent heart attacks and other vascular events.
Disclosures: The studies were independent of company funding. Dr. Rothwell has received honoraria for talks, advisory board participation, and clinical trial committee participation from multiple companies, including AstraZeneca, Bayer, Boehringer Ingelheim, Sanofi-Aventis/Bristol-Myers Squibb, and Servier, and is on the executive committee of the ARRIVE trial.
Laparoscopic Tops Transabdominal US for Polyp Detection
CHICAGO – Laparoscopic ultrasound was as effective as transabdominal ultrasound for detecting cholelithiasis, and superior at finding gallbladder polyps, based on data from 253 adults undergoing laparoscopic gastric bypass procedures.
Morbidly obese patients are at increased risk for cholelithiasis, with approximately 22%-52% developing the condition, said Dr. Kosisochi M. Obinwanne at the annual clinical congress of the American College of Surgeons.
For surgeons who perform gallbladder surgery separate from the gastric bypass, "it becomes necessary to obtain images of the gallbladder to determine the presence of gallstones," said Dr. Obinwanne of Gundersen Lutheran Health System in La Crosse, Wisc.
"Transabdominal ultrasound is the gold standard for detecting cholelithiasis," he said. However, the increased visceral and subcutaneous fat in patients with morbid obesity can make detection of gallbladder pathology difficult using transabdominal ultrasound (TAU), but laparoscopic ultrasound (LU) has the potential to be as effective as TAU, he noted.
To evaluate the sensitivity and specificity of LU vs. TAU for detecting gallbladder pathology in morbidly obese patients, Dr. Obinwanne and his colleagues conducted a prospective study of 253 patients who underwent laparoscopic gastric bypass over a 6-year period. Their average age was 43 years, average body mass index was 48 kg/m2, and 76% were women.
The patients underwent both TAU and LU during laparoscopic gastric bypass surgery. Certified ultrasonographers performed TAU, and surgeons blinded to the TAU results performed LU, Dr. Obinwanne said.
Overall, LU and TAU identified cholelithiasis in 60 and 61 patients, respectively, said Dr. Obinwanne. The average common bile duct diameter measurement was 3.7 mm with LU and 4.0 mm with TAU.
However, LU found significantly more gallbladder polyps than did TAU (41 vs. 6). The sensitivity and specificity of LU were 90% and 98%, respectively, for gallbladder pathology and 83% and 85%, respectively, for polyps.
"The mean time to complete an LU procedure was 4 minutes," Dr. Obinwanne said.
The study was limited by its small size, but the results suggest that LU is safe, quick, and easy to perform – and thus it’s an alternative to TAU for detecting gallbladder pathology in bariatric surgery patients.
Dr. Obinwanne had no financial conflicts to disclose.
CHICAGO – Laparoscopic ultrasound was as effective as transabdominal ultrasound for detecting cholelithiasis, and superior at finding gallbladder polyps, based on data from 253 adults undergoing laparoscopic gastric bypass procedures.
Morbidly obese patients are at increased risk for cholelithiasis, with approximately 22%-52% developing the condition, said Dr. Kosisochi M. Obinwanne at the annual clinical congress of the American College of Surgeons.
For surgeons who perform gallbladder surgery separate from the gastric bypass, "it becomes necessary to obtain images of the gallbladder to determine the presence of gallstones," said Dr. Obinwanne of Gundersen Lutheran Health System in La Crosse, Wisc.
"Transabdominal ultrasound is the gold standard for detecting cholelithiasis," he said. However, the increased visceral and subcutaneous fat in patients with morbid obesity can make detection of gallbladder pathology difficult using transabdominal ultrasound (TAU), but laparoscopic ultrasound (LU) has the potential to be as effective as TAU, he noted.
To evaluate the sensitivity and specificity of LU vs. TAU for detecting gallbladder pathology in morbidly obese patients, Dr. Obinwanne and his colleagues conducted a prospective study of 253 patients who underwent laparoscopic gastric bypass over a 6-year period. Their average age was 43 years, average body mass index was 48 kg/m2, and 76% were women.
The patients underwent both TAU and LU during laparoscopic gastric bypass surgery. Certified ultrasonographers performed TAU, and surgeons blinded to the TAU results performed LU, Dr. Obinwanne said.
Overall, LU and TAU identified cholelithiasis in 60 and 61 patients, respectively, said Dr. Obinwanne. The average common bile duct diameter measurement was 3.7 mm with LU and 4.0 mm with TAU.
However, LU found significantly more gallbladder polyps than did TAU (41 vs. 6). The sensitivity and specificity of LU were 90% and 98%, respectively, for gallbladder pathology and 83% and 85%, respectively, for polyps.
"The mean time to complete an LU procedure was 4 minutes," Dr. Obinwanne said.
The study was limited by its small size, but the results suggest that LU is safe, quick, and easy to perform – and thus it’s an alternative to TAU for detecting gallbladder pathology in bariatric surgery patients.
Dr. Obinwanne had no financial conflicts to disclose.
CHICAGO – Laparoscopic ultrasound was as effective as transabdominal ultrasound for detecting cholelithiasis, and superior at finding gallbladder polyps, based on data from 253 adults undergoing laparoscopic gastric bypass procedures.
Morbidly obese patients are at increased risk for cholelithiasis, with approximately 22%-52% developing the condition, said Dr. Kosisochi M. Obinwanne at the annual clinical congress of the American College of Surgeons.
For surgeons who perform gallbladder surgery separate from the gastric bypass, "it becomes necessary to obtain images of the gallbladder to determine the presence of gallstones," said Dr. Obinwanne of Gundersen Lutheran Health System in La Crosse, Wisc.
"Transabdominal ultrasound is the gold standard for detecting cholelithiasis," he said. However, the increased visceral and subcutaneous fat in patients with morbid obesity can make detection of gallbladder pathology difficult using transabdominal ultrasound (TAU), but laparoscopic ultrasound (LU) has the potential to be as effective as TAU, he noted.
To evaluate the sensitivity and specificity of LU vs. TAU for detecting gallbladder pathology in morbidly obese patients, Dr. Obinwanne and his colleagues conducted a prospective study of 253 patients who underwent laparoscopic gastric bypass over a 6-year period. Their average age was 43 years, average body mass index was 48 kg/m2, and 76% were women.
The patients underwent both TAU and LU during laparoscopic gastric bypass surgery. Certified ultrasonographers performed TAU, and surgeons blinded to the TAU results performed LU, Dr. Obinwanne said.
Overall, LU and TAU identified cholelithiasis in 60 and 61 patients, respectively, said Dr. Obinwanne. The average common bile duct diameter measurement was 3.7 mm with LU and 4.0 mm with TAU.
However, LU found significantly more gallbladder polyps than did TAU (41 vs. 6). The sensitivity and specificity of LU were 90% and 98%, respectively, for gallbladder pathology and 83% and 85%, respectively, for polyps.
"The mean time to complete an LU procedure was 4 minutes," Dr. Obinwanne said.
The study was limited by its small size, but the results suggest that LU is safe, quick, and easy to perform – and thus it’s an alternative to TAU for detecting gallbladder pathology in bariatric surgery patients.
Dr. Obinwanne had no financial conflicts to disclose.
AT THE ANNUAL CLINICAL CONGRESS OF THE AMERICAN COLLEGE OF SURGEONS
Major Finding: Laparoscopic ultrasound and transabdominal ultrasound detected gallbladder pathology in similar numbers of patients (60 vs. 61, respectively), but significantly more gallbladder polyps were found via laparoscopic ultrasound (41 vs. 6).
Data Source: The data come from a prospective study of 253 adults who underwent gastric bypass surgery at a single center.
Disclosures: Dr. Obinwanne had no financial conflicts to disclose.
Most Kids' Readmissions Stem From Initial Surgeries
CHICAGO – A majority of unplanned 30-day readmissions of general surgery patients to a pediatric hospital resulted from the initial surgery or procedure for which the child was hospitalized, according to data on more than 300 patients. The findings were presented at the annual clinical congress of the American College of Surgeons.
Hospital readmission within 30 days has become an important quality measure, but data on the frequency and epidemiology of pediatric surgery readmissions are limited, said Dr. Andre Marshall of Vanderbilt University, Nashville, Tenn.
"In order to decrease readmissions, pediatric surgeons must know where to focus efforts," he said.
To determine the proportion of readmissions associated with each surgical service, Dr. Marshall and colleagues reviewed data from 12,438 surgical admissions at a single center between January 2007 and December 2010. Data were taken from the Pediatric Health Information System database and electronic medical records.
A 30-day readmission was defined as any readmission within 30 days of an index hospitalization. Surgical services included general surgery, thoracic surgery, neurosurgery, cardiac surgery, orthopedics, otolaryngology, urologic surgery, ophthalmology, plastic surgery, and kidney and liver transplants.
In all, 1,178 patients were readmitted during the study period, for a readmission rate of 10%. Of these, 318 (27%) were general surgery readmissions. The next highest readmission rates by specialty were neurosurgery (26%), cardiac surgery (18%), and orthopedics (10%). The average age of the readmitted patients was 3 years, and 58% were male.
Of the 318 general surgery readmissions, 295 were unplanned, Dr. Marshall said. Of these, 174 (59%) were related to the index surgery or procedure, and 121 (41%) were related to a new illness, new trauma, or other reason not related to the initial procedure.
Among general surgery patients, infection complications were the most common reason for 30-day readmission (38%), followed by gastrointestinal issues (28%), respiratory complications (9%), planned readmissions (7%), postoperative pain (5%), and other (13%).
The most common preoperative diagnoses associated with 30-day readmission were acute appendicitis (18%), congenital malformations (17%), and gastroesophageal reflux disease (14%).
"Improving processes to anticipate which patients and diagnoses are at the greatest risk of 30-day readmission will potentially allow for early interventions by providers," Dr. Marshall said. Early intervention will allow clinicians to implement strategies to help reduce overall readmission rates and improve the quality of patient care, he added.
Dr. Marshall had no financial conflicts to disclose.
CHICAGO – A majority of unplanned 30-day readmissions of general surgery patients to a pediatric hospital resulted from the initial surgery or procedure for which the child was hospitalized, according to data on more than 300 patients. The findings were presented at the annual clinical congress of the American College of Surgeons.
Hospital readmission within 30 days has become an important quality measure, but data on the frequency and epidemiology of pediatric surgery readmissions are limited, said Dr. Andre Marshall of Vanderbilt University, Nashville, Tenn.
"In order to decrease readmissions, pediatric surgeons must know where to focus efforts," he said.
To determine the proportion of readmissions associated with each surgical service, Dr. Marshall and colleagues reviewed data from 12,438 surgical admissions at a single center between January 2007 and December 2010. Data were taken from the Pediatric Health Information System database and electronic medical records.
A 30-day readmission was defined as any readmission within 30 days of an index hospitalization. Surgical services included general surgery, thoracic surgery, neurosurgery, cardiac surgery, orthopedics, otolaryngology, urologic surgery, ophthalmology, plastic surgery, and kidney and liver transplants.
In all, 1,178 patients were readmitted during the study period, for a readmission rate of 10%. Of these, 318 (27%) were general surgery readmissions. The next highest readmission rates by specialty were neurosurgery (26%), cardiac surgery (18%), and orthopedics (10%). The average age of the readmitted patients was 3 years, and 58% were male.
Of the 318 general surgery readmissions, 295 were unplanned, Dr. Marshall said. Of these, 174 (59%) were related to the index surgery or procedure, and 121 (41%) were related to a new illness, new trauma, or other reason not related to the initial procedure.
Among general surgery patients, infection complications were the most common reason for 30-day readmission (38%), followed by gastrointestinal issues (28%), respiratory complications (9%), planned readmissions (7%), postoperative pain (5%), and other (13%).
The most common preoperative diagnoses associated with 30-day readmission were acute appendicitis (18%), congenital malformations (17%), and gastroesophageal reflux disease (14%).
"Improving processes to anticipate which patients and diagnoses are at the greatest risk of 30-day readmission will potentially allow for early interventions by providers," Dr. Marshall said. Early intervention will allow clinicians to implement strategies to help reduce overall readmission rates and improve the quality of patient care, he added.
Dr. Marshall had no financial conflicts to disclose.
CHICAGO – A majority of unplanned 30-day readmissions of general surgery patients to a pediatric hospital resulted from the initial surgery or procedure for which the child was hospitalized, according to data on more than 300 patients. The findings were presented at the annual clinical congress of the American College of Surgeons.
Hospital readmission within 30 days has become an important quality measure, but data on the frequency and epidemiology of pediatric surgery readmissions are limited, said Dr. Andre Marshall of Vanderbilt University, Nashville, Tenn.
"In order to decrease readmissions, pediatric surgeons must know where to focus efforts," he said.
To determine the proportion of readmissions associated with each surgical service, Dr. Marshall and colleagues reviewed data from 12,438 surgical admissions at a single center between January 2007 and December 2010. Data were taken from the Pediatric Health Information System database and electronic medical records.
A 30-day readmission was defined as any readmission within 30 days of an index hospitalization. Surgical services included general surgery, thoracic surgery, neurosurgery, cardiac surgery, orthopedics, otolaryngology, urologic surgery, ophthalmology, plastic surgery, and kidney and liver transplants.
In all, 1,178 patients were readmitted during the study period, for a readmission rate of 10%. Of these, 318 (27%) were general surgery readmissions. The next highest readmission rates by specialty were neurosurgery (26%), cardiac surgery (18%), and orthopedics (10%). The average age of the readmitted patients was 3 years, and 58% were male.
Of the 318 general surgery readmissions, 295 were unplanned, Dr. Marshall said. Of these, 174 (59%) were related to the index surgery or procedure, and 121 (41%) were related to a new illness, new trauma, or other reason not related to the initial procedure.
Among general surgery patients, infection complications were the most common reason for 30-day readmission (38%), followed by gastrointestinal issues (28%), respiratory complications (9%), planned readmissions (7%), postoperative pain (5%), and other (13%).
The most common preoperative diagnoses associated with 30-day readmission were acute appendicitis (18%), congenital malformations (17%), and gastroesophageal reflux disease (14%).
"Improving processes to anticipate which patients and diagnoses are at the greatest risk of 30-day readmission will potentially allow for early interventions by providers," Dr. Marshall said. Early intervention will allow clinicians to implement strategies to help reduce overall readmission rates and improve the quality of patient care, he added.
Dr. Marshall had no financial conflicts to disclose.
AT THE ANNUAL CLINICAL CONGRESS OF THE AMERICAN COLLEGE OF SURGEONS
Major Finding: More than half (59%) of 30-day readmissions for pediatric general surgery patients were related to their initial surgeries or procedures.
Data Source: The data come from 12,438 surgical admissions at a single center between January 2007 and December 2010.
Disclosures: Dr. Marshall had no financial conflicts to disclose.
Colorectal Surgery Complication Risk Factors Identified
Operating room time, body mass index, and the surgeon performing the procedure were the top three factors affecting readmission rates, transfusion rates, and surgical site infections after colorectal surgery in a single-center prospective study of more than 3,000 patients.
Many previous studies have addressed risk factors and surgical outcomes, but "little is known about the relative contribution of various risk factors to specific outcomes," said Elena Manilich, Ph.D., of the Cleveland Clinic. She presented the findings at the annual meeting of the American Society of Colon and Rectal Surgeons.
She and her colleagues analyzed outcomes from 3,552 patients who underwent colorectal surgery. Their average age at the time of surgery was 51 years, and approximately half were women. Cancer was the most common indication for surgery (16%).
Overall, the length of surgery was significantly associated with increased complication rates, Dr. Manilich said. In particular, the adjusted odds ratios for procedures lasting more than 200 minutes vs. those lasting less than 200 minutes were 2.79 for transfusion, 2.11 for surgical site infection and abscess, and 2.09 for wound infection.
Surgeons who performed fewer than 20 procedures were significant predictors of surgical site infections, abscesses, reoperation, and anastomotic leaks in their patients, Dr. Manilich said.
Increased patient body mass index was independently associated with wound infection, surgical site infection, and portal and deep vein thrombosis, she added.
In addition, a patient age older than 75 years was independently associated with transfusion and reoperation.
The outcomes that were most influenced by complications were hospital readmission, transfusion, surgical site infection, wound infections, and abscesses. Complications were defined as outcomes that occurred prior to hospital discharge or within 30 days of the initial surgery.
The findings were limited by the use of data from a single hospital and by the inability to adjust for patient histories (such as prior abdominal procedures) that might have affected the outcomes, Dr. Manilich said. But the study is unique in its use of a logistic regression analysis to identify which variables predict which outcomes, she added.
"An understanding of these results may be useful to colorectal surgeons who are making an effort to understand and improve their surgical outcomes," she said.
Dr. Manilich had no financial conflicts to disclose.
Operating room time, body mass index, and the surgeon performing the procedure were the top three factors affecting readmission rates, transfusion rates, and surgical site infections after colorectal surgery in a single-center prospective study of more than 3,000 patients.
Many previous studies have addressed risk factors and surgical outcomes, but "little is known about the relative contribution of various risk factors to specific outcomes," said Elena Manilich, Ph.D., of the Cleveland Clinic. She presented the findings at the annual meeting of the American Society of Colon and Rectal Surgeons.
She and her colleagues analyzed outcomes from 3,552 patients who underwent colorectal surgery. Their average age at the time of surgery was 51 years, and approximately half were women. Cancer was the most common indication for surgery (16%).
Overall, the length of surgery was significantly associated with increased complication rates, Dr. Manilich said. In particular, the adjusted odds ratios for procedures lasting more than 200 minutes vs. those lasting less than 200 minutes were 2.79 for transfusion, 2.11 for surgical site infection and abscess, and 2.09 for wound infection.
Surgeons who performed fewer than 20 procedures were significant predictors of surgical site infections, abscesses, reoperation, and anastomotic leaks in their patients, Dr. Manilich said.
Increased patient body mass index was independently associated with wound infection, surgical site infection, and portal and deep vein thrombosis, she added.
In addition, a patient age older than 75 years was independently associated with transfusion and reoperation.
The outcomes that were most influenced by complications were hospital readmission, transfusion, surgical site infection, wound infections, and abscesses. Complications were defined as outcomes that occurred prior to hospital discharge or within 30 days of the initial surgery.
The findings were limited by the use of data from a single hospital and by the inability to adjust for patient histories (such as prior abdominal procedures) that might have affected the outcomes, Dr. Manilich said. But the study is unique in its use of a logistic regression analysis to identify which variables predict which outcomes, she added.
"An understanding of these results may be useful to colorectal surgeons who are making an effort to understand and improve their surgical outcomes," she said.
Dr. Manilich had no financial conflicts to disclose.
Operating room time, body mass index, and the surgeon performing the procedure were the top three factors affecting readmission rates, transfusion rates, and surgical site infections after colorectal surgery in a single-center prospective study of more than 3,000 patients.
Many previous studies have addressed risk factors and surgical outcomes, but "little is known about the relative contribution of various risk factors to specific outcomes," said Elena Manilich, Ph.D., of the Cleveland Clinic. She presented the findings at the annual meeting of the American Society of Colon and Rectal Surgeons.
She and her colleagues analyzed outcomes from 3,552 patients who underwent colorectal surgery. Their average age at the time of surgery was 51 years, and approximately half were women. Cancer was the most common indication for surgery (16%).
Overall, the length of surgery was significantly associated with increased complication rates, Dr. Manilich said. In particular, the adjusted odds ratios for procedures lasting more than 200 minutes vs. those lasting less than 200 minutes were 2.79 for transfusion, 2.11 for surgical site infection and abscess, and 2.09 for wound infection.
Surgeons who performed fewer than 20 procedures were significant predictors of surgical site infections, abscesses, reoperation, and anastomotic leaks in their patients, Dr. Manilich said.
Increased patient body mass index was independently associated with wound infection, surgical site infection, and portal and deep vein thrombosis, she added.
In addition, a patient age older than 75 years was independently associated with transfusion and reoperation.
The outcomes that were most influenced by complications were hospital readmission, transfusion, surgical site infection, wound infections, and abscesses. Complications were defined as outcomes that occurred prior to hospital discharge or within 30 days of the initial surgery.
The findings were limited by the use of data from a single hospital and by the inability to adjust for patient histories (such as prior abdominal procedures) that might have affected the outcomes, Dr. Manilich said. But the study is unique in its use of a logistic regression analysis to identify which variables predict which outcomes, she added.
"An understanding of these results may be useful to colorectal surgeons who are making an effort to understand and improve their surgical outcomes," she said.
Dr. Manilich had no financial conflicts to disclose.
Major Finding: Operating time had a significant impact on the outcomes of colorectal procedures. The adjusted odds ratio for procedures lasting more than 200 minutes, compared with those lasting less than 200 minutes, was 2.79 for transfusion, 2.11 for surgical site infection and abscess, and 2.09 for wound infection.
Data Source: The data come from an outcomes database of adults who underwent colorectal surgery in 2010 and 2011.
Disclosures: Dr. Manilich had no financial conflicts to disclose.
Early Oral Feeding Benefits Bowel Surgery Patients
CHICAGO – A total of 80% of bowel resection patients tolerated early fluids one day after surgery, based on data from 100 patients.
"Early oral feeding is an important part of fast-track surgery, which enhances recovery after surgery," but feeding in patients undergoing emergency bowel resection is often delayed until the resolution of ileus, Dr. Mohamed E. Shams of Suez Canal University in Ismailia, Egypt, said at the annual clinical congress of the American College of Surgeons.
Dr. Shams and colleagues randomized 100 adults who underwent small or large bowel resection into two groups. The early group comprised 50 patients who received fluid oral feedings on the first day after surgery. The late group comprised 50 patients who received oral feedings after the resolution of ileus.
Overall, 80% of patients in the early group tolerated the early oral feeding. In addition, patients in the early group averaged a significantly shorter time than did the late group to the passage of flatus (3.2 days vs. 0.8 days, respectively), and stool (4.4 days vs. 1.2 days, respectively).
Postoperative monitoring showed that the chest infections occurred in four patients in the early feeding group compared with 10 patients in the late feeding group, while wound infections occurred in 12 patients in the early group and 15 patients in the late group, Dr. Shams said. No incidents of a burst abdomen occurred in the early group, and three incidents occurred in the late group.
"Early oral feeding after emergency intestinal surgery is safe and well tolerated by the majority of patients, without an increase in mortality and morbidity risk," said Dr. Shams. "It also has a positive impact on reduction in hospital stay," he said.
The findings were limited by the small number of patients, but the results suggest that a majority of patients undergoing emergency intestinal surgery can benefit from early feeding, Dr. Shams noted.
Dr. Shams had no financial conflicts to disclose.
CHICAGO – A total of 80% of bowel resection patients tolerated early fluids one day after surgery, based on data from 100 patients.
"Early oral feeding is an important part of fast-track surgery, which enhances recovery after surgery," but feeding in patients undergoing emergency bowel resection is often delayed until the resolution of ileus, Dr. Mohamed E. Shams of Suez Canal University in Ismailia, Egypt, said at the annual clinical congress of the American College of Surgeons.
Dr. Shams and colleagues randomized 100 adults who underwent small or large bowel resection into two groups. The early group comprised 50 patients who received fluid oral feedings on the first day after surgery. The late group comprised 50 patients who received oral feedings after the resolution of ileus.
Overall, 80% of patients in the early group tolerated the early oral feeding. In addition, patients in the early group averaged a significantly shorter time than did the late group to the passage of flatus (3.2 days vs. 0.8 days, respectively), and stool (4.4 days vs. 1.2 days, respectively).
Postoperative monitoring showed that the chest infections occurred in four patients in the early feeding group compared with 10 patients in the late feeding group, while wound infections occurred in 12 patients in the early group and 15 patients in the late group, Dr. Shams said. No incidents of a burst abdomen occurred in the early group, and three incidents occurred in the late group.
"Early oral feeding after emergency intestinal surgery is safe and well tolerated by the majority of patients, without an increase in mortality and morbidity risk," said Dr. Shams. "It also has a positive impact on reduction in hospital stay," he said.
The findings were limited by the small number of patients, but the results suggest that a majority of patients undergoing emergency intestinal surgery can benefit from early feeding, Dr. Shams noted.
Dr. Shams had no financial conflicts to disclose.
CHICAGO – A total of 80% of bowel resection patients tolerated early fluids one day after surgery, based on data from 100 patients.
"Early oral feeding is an important part of fast-track surgery, which enhances recovery after surgery," but feeding in patients undergoing emergency bowel resection is often delayed until the resolution of ileus, Dr. Mohamed E. Shams of Suez Canal University in Ismailia, Egypt, said at the annual clinical congress of the American College of Surgeons.
Dr. Shams and colleagues randomized 100 adults who underwent small or large bowel resection into two groups. The early group comprised 50 patients who received fluid oral feedings on the first day after surgery. The late group comprised 50 patients who received oral feedings after the resolution of ileus.
Overall, 80% of patients in the early group tolerated the early oral feeding. In addition, patients in the early group averaged a significantly shorter time than did the late group to the passage of flatus (3.2 days vs. 0.8 days, respectively), and stool (4.4 days vs. 1.2 days, respectively).
Postoperative monitoring showed that the chest infections occurred in four patients in the early feeding group compared with 10 patients in the late feeding group, while wound infections occurred in 12 patients in the early group and 15 patients in the late group, Dr. Shams said. No incidents of a burst abdomen occurred in the early group, and three incidents occurred in the late group.
"Early oral feeding after emergency intestinal surgery is safe and well tolerated by the majority of patients, without an increase in mortality and morbidity risk," said Dr. Shams. "It also has a positive impact on reduction in hospital stay," he said.
The findings were limited by the small number of patients, but the results suggest that a majority of patients undergoing emergency intestinal surgery can benefit from early feeding, Dr. Shams noted.
Dr. Shams had no financial conflicts to disclose.
FROM THE ANNUAL CLINICAL CONGRESS OF THE AMERICAN COLLEGE OF SURGEONS
Major Finding: Eighty percent of patients who received oral fluids on the first day after surgery vs. delayed feeding had significantly shorter time to the passage of flatus (3.2 days vs. 0.8 days, respectively), and stool (4.4 days vs. 1.2 days, respectively).
Data Source: The data come from a randomized trial of 100 adults who underwent bowel resection.
Disclosures: Dr. Shams reported having no financial conflicts.
Kids' Outcomes Equal Across Pediatric, Adult Trauma Centers
CHICAGO – Outcomes for children seen at pediatric trauma centers were not significantly different than for children seen at adult trauma centers, according to a review of more than 45,000 pediatric injuries.
The finding "has significant policy implications because it means that emergency medical services do not have to triage patients according to specialty care centers," and it informs discussions about pediatric access to trauma care, said researcher Dr. Cassandra Villegas of the University of Arizona in Tucson.
Trauma accounts for approximately one-third of all pediatric mortality, but there are only 170 pediatric-specific trauma centers in the United States, which "means that the vast majority of pediatric patients that are injured are actually managed and evaluated at adult trauma centers," Dr. Villegas said at the annual clinical congress of the American College of Surgeons.
Nonetheless, data on pediatric outcomes for children treated at pediatric vs. adult trauma centers have not been conclusive, and most previous studies have focused on metropolitan or state pediatric centers, she said.
Dr. Villegas and her colleagues reviewed data from the National Trauma Database for 2007-2008 that included 27 pediatric trauma centers and 30 adult (mixed care) centers that had pediatric beds. Most (90%) of the 30 mixed care centers provided all acute pediatric services, while 10% shared these services with another medical center. All of the pediatric centers and 90% of the mixed care centers had pediatric intensive care units. The pediatric centers were significantly more likely to be university hospitals than were the mixed centers (85% vs. 53%).
The researchers analyzed outcomes for children aged 0-14 years, including 33,327 patients treated at pediatric centers and 12,605 patients treated at mixed centers.
After controlling for multiple variables including injury characteristics, Dr. Villegas and her associates found that in-hospital mortality – the primary outcome – was twice as high at mixed centers as at pediatric centers (2% vs. 1%), but this difference was not significant. The median length of stay was 2 days at all centers, although ICU admission rates were higher at mixed centers vs. pediatric centers (26% vs. 14%).
Approximately one-third of the patients seen at either type of center had an Injury Severity Score (ISS) in the 9-15 range, said Dr. Villegas. Falls were the most common type of injury, accounting for 49% of cases at pediatric centers and 37% of cases at mixed centers.
The patients at mixed centers were more likely than those at pediatric centers to be hypotensive (18% vs. 10%).
The study was limited by several factors, including the low incidence of pediatric mortality, the lack of uniform coding for death on arrival, and differences in ICU admission practices, said Dr. Villegas.
However, the findings suggest that there are no differences in outcomes for children treated at pediatric vs. mixed care centers, she said.
Dr. Villegas reported having no financial conflicts of interest.
CHICAGO – Outcomes for children seen at pediatric trauma centers were not significantly different than for children seen at adult trauma centers, according to a review of more than 45,000 pediatric injuries.
The finding "has significant policy implications because it means that emergency medical services do not have to triage patients according to specialty care centers," and it informs discussions about pediatric access to trauma care, said researcher Dr. Cassandra Villegas of the University of Arizona in Tucson.
Trauma accounts for approximately one-third of all pediatric mortality, but there are only 170 pediatric-specific trauma centers in the United States, which "means that the vast majority of pediatric patients that are injured are actually managed and evaluated at adult trauma centers," Dr. Villegas said at the annual clinical congress of the American College of Surgeons.
Nonetheless, data on pediatric outcomes for children treated at pediatric vs. adult trauma centers have not been conclusive, and most previous studies have focused on metropolitan or state pediatric centers, she said.
Dr. Villegas and her colleagues reviewed data from the National Trauma Database for 2007-2008 that included 27 pediatric trauma centers and 30 adult (mixed care) centers that had pediatric beds. Most (90%) of the 30 mixed care centers provided all acute pediatric services, while 10% shared these services with another medical center. All of the pediatric centers and 90% of the mixed care centers had pediatric intensive care units. The pediatric centers were significantly more likely to be university hospitals than were the mixed centers (85% vs. 53%).
The researchers analyzed outcomes for children aged 0-14 years, including 33,327 patients treated at pediatric centers and 12,605 patients treated at mixed centers.
After controlling for multiple variables including injury characteristics, Dr. Villegas and her associates found that in-hospital mortality – the primary outcome – was twice as high at mixed centers as at pediatric centers (2% vs. 1%), but this difference was not significant. The median length of stay was 2 days at all centers, although ICU admission rates were higher at mixed centers vs. pediatric centers (26% vs. 14%).
Approximately one-third of the patients seen at either type of center had an Injury Severity Score (ISS) in the 9-15 range, said Dr. Villegas. Falls were the most common type of injury, accounting for 49% of cases at pediatric centers and 37% of cases at mixed centers.
The patients at mixed centers were more likely than those at pediatric centers to be hypotensive (18% vs. 10%).
The study was limited by several factors, including the low incidence of pediatric mortality, the lack of uniform coding for death on arrival, and differences in ICU admission practices, said Dr. Villegas.
However, the findings suggest that there are no differences in outcomes for children treated at pediatric vs. mixed care centers, she said.
Dr. Villegas reported having no financial conflicts of interest.
CHICAGO – Outcomes for children seen at pediatric trauma centers were not significantly different than for children seen at adult trauma centers, according to a review of more than 45,000 pediatric injuries.
The finding "has significant policy implications because it means that emergency medical services do not have to triage patients according to specialty care centers," and it informs discussions about pediatric access to trauma care, said researcher Dr. Cassandra Villegas of the University of Arizona in Tucson.
Trauma accounts for approximately one-third of all pediatric mortality, but there are only 170 pediatric-specific trauma centers in the United States, which "means that the vast majority of pediatric patients that are injured are actually managed and evaluated at adult trauma centers," Dr. Villegas said at the annual clinical congress of the American College of Surgeons.
Nonetheless, data on pediatric outcomes for children treated at pediatric vs. adult trauma centers have not been conclusive, and most previous studies have focused on metropolitan or state pediatric centers, she said.
Dr. Villegas and her colleagues reviewed data from the National Trauma Database for 2007-2008 that included 27 pediatric trauma centers and 30 adult (mixed care) centers that had pediatric beds. Most (90%) of the 30 mixed care centers provided all acute pediatric services, while 10% shared these services with another medical center. All of the pediatric centers and 90% of the mixed care centers had pediatric intensive care units. The pediatric centers were significantly more likely to be university hospitals than were the mixed centers (85% vs. 53%).
The researchers analyzed outcomes for children aged 0-14 years, including 33,327 patients treated at pediatric centers and 12,605 patients treated at mixed centers.
After controlling for multiple variables including injury characteristics, Dr. Villegas and her associates found that in-hospital mortality – the primary outcome – was twice as high at mixed centers as at pediatric centers (2% vs. 1%), but this difference was not significant. The median length of stay was 2 days at all centers, although ICU admission rates were higher at mixed centers vs. pediatric centers (26% vs. 14%).
Approximately one-third of the patients seen at either type of center had an Injury Severity Score (ISS) in the 9-15 range, said Dr. Villegas. Falls were the most common type of injury, accounting for 49% of cases at pediatric centers and 37% of cases at mixed centers.
The patients at mixed centers were more likely than those at pediatric centers to be hypotensive (18% vs. 10%).
The study was limited by several factors, including the low incidence of pediatric mortality, the lack of uniform coding for death on arrival, and differences in ICU admission practices, said Dr. Villegas.
However, the findings suggest that there are no differences in outcomes for children treated at pediatric vs. mixed care centers, she said.
Dr. Villegas reported having no financial conflicts of interest.
FROM THE ANNUAL CLINICAL CONGRESS OF THE AMERICAN COLLEGE OF SURGEONS
Major Finding: In-hospital mortality for children aged 0-14 years was twice as high for those treated at mixed centers as for those treated at pediatric centers (2% vs. 1%), but this difference was not significant.
Data Source: The data come from the National Trauma Database for 2007-2008, and included 33,327 patients treated at pediatric centers and 12,605 patients treated at mixed centers.
Disclosures: Dr. Villegas reported having no financial conflicts of interest.
Bariatric Surgery Safety Has Increased With Medicare Coverage
CHICAGO – Complication rates for bariatric surgery patients on Medicare declined after Medicare began to cover the procedure in 2006, an analysis of state inpatient data from 12 states has found.
Data from previous studies suggest that bariatric surgery outcomes for Medicare patients improved after the implementation of Medicare’s National Coverage Determination in 2006, said Dr. Justin B. Dimick of the University of Michigan, Ann Arbor. But specific safety data on Medicare patients who have undergone bariatric surgery since the time of the decision are limited, Dr. Dimick said. The decision allowed for Medicare coverage of patients who sought care at facilities certified by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery.
To assess the impact of the National Coverage Determination on the safety of bariatric surgery, Dr. Dimick and his colleagues reviewed state inpatient data from 12 large, geographically dispersed states. Patients were identified on the basis of ICD-9 codes and diagnosis-related groups for weight loss surgery.
The outcomes were categorized according to any complication, a serious complication, or a reoperation.
The percentage of Medicare patients with any complications dropped from 12% before the determination to 8% afterward. Similarly, the percentage of non-Medicare patients with any complications dropped from 7% before to 5% after the determination.
In a multivariate analysis, the factors contributing to improved outcomes for bariatric surgery in Medicare patients were an increase in the use of laparoscopic gastric banding (lap band surgery), the transfer of patients to better hospitals, and quality improvement within individual hospitals, Dr. Dimick said.
Improvements in the safety of bariatric surgery did not, however, result from patients being redirected to safer hospitals, said Dr. Dimick. In fact, complication rates for procedures performed at Centers of Excellence versus non–Centers of Excellence were not significantly different (odds ratio for any complications, 0.97), he noted.
"CMS should consider dropping the COE [Centers of Excellence] aspect of the coverage decision [that] limits patient access without a beneficial improvement in outcomes," Dr. Dimick said. "Alternatively, CMS could revise the national coverage decision to further encourage participation in a quality improvement registry." Such a registry would need to include measures of long-term effectiveness to identify any unintended consequences of the increase in lap band surgery, he added.
Dr. Dimick is an equity owner and cofounder of ArborMetrix, a health care analytics and software firm.
CHICAGO – Complication rates for bariatric surgery patients on Medicare declined after Medicare began to cover the procedure in 2006, an analysis of state inpatient data from 12 states has found.
Data from previous studies suggest that bariatric surgery outcomes for Medicare patients improved after the implementation of Medicare’s National Coverage Determination in 2006, said Dr. Justin B. Dimick of the University of Michigan, Ann Arbor. But specific safety data on Medicare patients who have undergone bariatric surgery since the time of the decision are limited, Dr. Dimick said. The decision allowed for Medicare coverage of patients who sought care at facilities certified by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery.
To assess the impact of the National Coverage Determination on the safety of bariatric surgery, Dr. Dimick and his colleagues reviewed state inpatient data from 12 large, geographically dispersed states. Patients were identified on the basis of ICD-9 codes and diagnosis-related groups for weight loss surgery.
The outcomes were categorized according to any complication, a serious complication, or a reoperation.
The percentage of Medicare patients with any complications dropped from 12% before the determination to 8% afterward. Similarly, the percentage of non-Medicare patients with any complications dropped from 7% before to 5% after the determination.
In a multivariate analysis, the factors contributing to improved outcomes for bariatric surgery in Medicare patients were an increase in the use of laparoscopic gastric banding (lap band surgery), the transfer of patients to better hospitals, and quality improvement within individual hospitals, Dr. Dimick said.
Improvements in the safety of bariatric surgery did not, however, result from patients being redirected to safer hospitals, said Dr. Dimick. In fact, complication rates for procedures performed at Centers of Excellence versus non–Centers of Excellence were not significantly different (odds ratio for any complications, 0.97), he noted.
"CMS should consider dropping the COE [Centers of Excellence] aspect of the coverage decision [that] limits patient access without a beneficial improvement in outcomes," Dr. Dimick said. "Alternatively, CMS could revise the national coverage decision to further encourage participation in a quality improvement registry." Such a registry would need to include measures of long-term effectiveness to identify any unintended consequences of the increase in lap band surgery, he added.
Dr. Dimick is an equity owner and cofounder of ArborMetrix, a health care analytics and software firm.
CHICAGO – Complication rates for bariatric surgery patients on Medicare declined after Medicare began to cover the procedure in 2006, an analysis of state inpatient data from 12 states has found.
Data from previous studies suggest that bariatric surgery outcomes for Medicare patients improved after the implementation of Medicare’s National Coverage Determination in 2006, said Dr. Justin B. Dimick of the University of Michigan, Ann Arbor. But specific safety data on Medicare patients who have undergone bariatric surgery since the time of the decision are limited, Dr. Dimick said. The decision allowed for Medicare coverage of patients who sought care at facilities certified by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery.
To assess the impact of the National Coverage Determination on the safety of bariatric surgery, Dr. Dimick and his colleagues reviewed state inpatient data from 12 large, geographically dispersed states. Patients were identified on the basis of ICD-9 codes and diagnosis-related groups for weight loss surgery.
The outcomes were categorized according to any complication, a serious complication, or a reoperation.
The percentage of Medicare patients with any complications dropped from 12% before the determination to 8% afterward. Similarly, the percentage of non-Medicare patients with any complications dropped from 7% before to 5% after the determination.
In a multivariate analysis, the factors contributing to improved outcomes for bariatric surgery in Medicare patients were an increase in the use of laparoscopic gastric banding (lap band surgery), the transfer of patients to better hospitals, and quality improvement within individual hospitals, Dr. Dimick said.
Improvements in the safety of bariatric surgery did not, however, result from patients being redirected to safer hospitals, said Dr. Dimick. In fact, complication rates for procedures performed at Centers of Excellence versus non–Centers of Excellence were not significantly different (odds ratio for any complications, 0.97), he noted.
"CMS should consider dropping the COE [Centers of Excellence] aspect of the coverage decision [that] limits patient access without a beneficial improvement in outcomes," Dr. Dimick said. "Alternatively, CMS could revise the national coverage decision to further encourage participation in a quality improvement registry." Such a registry would need to include measures of long-term effectiveness to identify any unintended consequences of the increase in lap band surgery, he added.
Dr. Dimick is an equity owner and cofounder of ArborMetrix, a health care analytics and software firm.
AT THE ANNUAL CLINICAL CONGRESS OF THE AMERICAN COLLEGE OF SURGEONS
Major Finding: The percentage of Medicare patients with any complications dropped from 12% before the National Coverage Determination to 8% afterward.
Data Source: The data come from state inpatient data from 12 states.
Disclosures: Dr. Dimick is an equity owner and cofounder of ArborMetrix, a health care analytics and software firm.
