Acute and Critical Care

Original Articles

Trauma
Elixhauser comorbidity measures-based risk factors associated with 30-day mortality in elderly population after femur fracture surgery: a propensity scorematched retrospective case-control study: Dohyung Kim, Hyunmin Jo, Younsuk Lee, Kyoung Ok Kim; Acute Crit Care. 2020;35(1):10-15. Published online February 29, 2020; DOI: https://doi.org/10.4266/acc.2019.00745

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Background
As the average life expectancy increases, anesthesiologists confront unique challenges in the perioperative care of elderly patients who have significant comorbidities. In this study, we evaluated Elixhauser comorbidity measures-based risk factors associated with 30day mortality in patients aged 66 years and older who underwent femur fracture surgery. Methods: We used the Medical Information Mart for Intensive Care III which contains the medical records of patients admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center in the United States between 2001 and 2012 to identify patients admitted to the ICU after femur fracture surgery (n=209). Patients who died within 30 days of admission (case group, n=49) were propensity score-matched to patients who did not (control group, n=98). The variables for matching were age, sex, race, anemia (hemoglobin ≤10 g/dl), and malignancy. We attempted to explain mortality via nine independent factors: hypertension, uncomplicated diabetes, complicated diabetes, congestive heart failure (CHF), cardiac arrhythmias, chronic pulmonary disease, renal failure, neurological disorders other than paralysis, and peripheral vascular disease. Results: Logistic regression identified three significant risk factors: CHF, arrhythmias, and neurological disorders other than paralysis. The odds ratio (OR) for the 30-day mortality of CHF was 4.99 (95% confidence interval [CI], 2.18 to 12.06). The equivalent ORs for cardiac arrhythmias and neurological disorders other than paralysis were 2.61 (95% CI, 1.14 to 6.21) and 2.40 (95% CI, 0.95 to 6.48), respectively. Conclusions: Identifying patients with these risk factors (CHF, arrhythmias, and neurological disorders other than paralysis) will assist clinicians with perioperative planning and provide caregivers with valuable information for decision-making.

Citations

Citations to this article as recorded by

A machine learning-based prediction model for in-hospital mortality among critically ill patients with hip fracture: An internal and external validated study
Mingxing Lei, Zhencan Han, Shengjie Wang, Tao Han, Shenyun Fang, Feng Lin, Tianlong Huang
Injury.2023; 54(2): 636. CrossRef
Complications and hospitalization costs in patients with hypothyroidism following total hip arthroplasty
Yuanyuan Huang, Yuzhi Huang, Yuhang Chen, Qinfeng Yang, Binyan Yin
Journal of Orthopaedic Surgery and Research.2023;[Epub] CrossRef
How age and gender influence proximal humerus fracture management in patients older than fifty years
Akshar H. Patel, J. Heath Wilder, Sione A. Ofa, Olivia C. Lee, Michael C. Iloanya, Felix H. Savoie, William F. Sherman
JSES International.2022; 6(2): 253. CrossRef
Comorbidity indices in orthopaedic surgery: a narrative review focused on hip and knee arthroplasty
SaTia T. Sinclair, Ahmed K. Emara, Melissa N. Orr, Kara M. McConaghy, Alison K. Klika, Nicolas S. Piuzzi
EFORT Open Reviews.2021; 6(8): 629. CrossRef

Thoracic Surgery
Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation: Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Dohyung Kim; Korean J Crit Care Med. 2017;32(2):197-204. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00059

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174 Download
5 Web of Science
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Abstract PDF

Background
The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO.
Methods
From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST.
Results
Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×10⁹/L (range, 46 to 434 ×10⁹/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST.
Conclusions
The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.

Citations

Citations to this article as recorded by

Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience
Phillip Staibano, Shahzaib Khattak, Faizan Amin, Paul T. Engels, Doron D. Sommer
Annals of Otology, Rhinology & Laryngology.2023; 132(12): 1520. CrossRef
Does Tracheostomy Improve Outcomes in Those Receiving Venovenous Extracorporeal Membrane Oxygenation?
Joel C. Boudreaux, Marian Urban, Shaun L. Thompson, Anthony W. Castleberry, Michael J. Moulton, Aleem Siddique
ASAIO Journal.2023; 69(6): e240. CrossRef
Tracheostomy in high-risk patients on ECMO: A bedside hybrid dilational technique utilizing a Rummel tourniquet
Britton B. Donato, Marisa Sewell, Megan Campany, Ga-ram Han, Taylor S. Orton, Marko Laitinen, Jacob Hammond, Xindi Chen, Jasmina Ingersoll, Ayan Sen, Jonathan D'Cunha
Surgery Open Science.2023; 16: 248. CrossRef
Assessing Clinical Feasibility and Safety of Percutaneous Dilatational Tracheostomy During Extracorporeal Membrane Oxygenation Support in the Intensive Care Unit
Tae Hwa Hong, Hyung Won Kim, Hyoung Soo Kim, Sunghoon Park
Journal of Acute Care Surgery.2022; 12(1): 18. CrossRef
Retrospective analysis of open bedside tracheotomies in a German tertiary care university hospital
Maximilian Riekert, Matthias Kreppel, Philipp Schminke, Annelies Weckx, Joachim E. Zöller, Volker C. Schick
Journal of Cranio-Maxillofacial Surgery.2021; 49(2): 140. CrossRef
Otolaryngology during COVID-19: Preventive care and precautionary measures
Chen Zhao, Alonço Viana, Yan Wang, Hong-quan Wei, Ai-hui Yan, Robson Capasso
American Journal of Otolaryngology.2020; 41(4): 102508. CrossRef
Tracheostomy while on Extracorporeal Membrane Oxygenation: A Comparison of Percutaneous and Open Procedures
Ismael A. Salas De Armas, Kha Dinh, Bindu Akkanti, Pushan Jani, Reshma Hussain, Lisa Janowiak, Kayla Kutilek, Manish K. Patel, Mehmet H. Akay, Rahat Hussain, Jayeshkumar Patel, Chandni Patel, Yafen Liang, John Zaki, Biswajit Kar, Igor D. Gregoric
The Journal of ExtraCorporeal Technology.2020; 52(4): 266. CrossRef

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