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Background
To determine patient-related risk factors for infection following knee arthroscopy using two large databases.Methods
A private-payer (PP) and Medicare national insurance database were queried for patients undergoing simple knee arthroscopy procedures from 2005 to 2015. Patients undergoing concomitant open or complex procedures with grafts were excluded. Postoperative infection within 90 days was assessed using ICD-9 and CPT codes. A multivariate logistic regression analysis was utilized to evaluate patient-related risk factors for postoperative infection. Adjusted odds ratios (OR) and 95% confidence intervals were calculated for each risk factor, with P < 0.05 considered statistically significant.Results
One hundred thousand three hundred ninety nine patients from the PP database and 629,842 patients from the Medicare database met all inclusion and exclusion criteria. In the PP database, there were 250 patients with documented infections (0.25%); the incidence of infection was similar in the Medicare database (1755 patients, 0.28%). There were numerous patient-related comorbidities and demographics independently associated with a significantly increased risk of postoperative infection that were similar across the PP and Medicare patient populations, respectively, including younger age (OR = 1.27, 1.43), morbid obesity (OR = 1.26, 1.74), tobacco use (OR = 1.34, 1.48), inflammatory arthritis (OR = 1.61, 1.60), chronic kidney disease (OR = 1.65, 1.14), hemodialysis (OR = 1.93, 1.36), depression (OR = 2.02, 1.73), and a hypercoagulable disorder (OR = 2.76, 1.58).Conclusion
The present study identified numerous patient-related risk factors independently associated with an increased risk of infection following knee arthroscopy in PP and Medicare-aged patients. 相似文献We sought to identify patients with hypertrophic cardiomyopathy (HCM) at high risk of sudden death (SD).
BACKGROUND
Relatively low mortality rates in HCM make conventional analysis of multiple clinical risk markers for SD problematic. This study used a referral center registry to investigate a smaller number of generally accepted noninvasive risk markers.
METHODS
We studied 368 patients (14 to 65 years old, 239 males) with HCM. There were five variables: nonsustained ventricular tachycardia (NSVT), syncope, exercise blood pressure response (BPR), family history of sudden death (FHSD) and left ventricular wall thickness (LVWT).
RESULTS
During follow-up (3.6 ± 2.5 years [range 2 days to 9.6 years]), 36 patients (9.8%) died, 22 of them suddenly. Two patients received heart transplants. The six-year SD-free survival rate was 91% (95% confidence interval [CI] 87% to 95%). In the Cox model, there was a significant pairwise interaction between FHSD and syncope (p = 0.01), and these were subsequently considered together. The multivariate SD risk ratios (with 95% CIs) were 1.8 for BPR (0.7 to 4.4) (p = 0.22); 5.3 for FHSD and syncope (1.9 to 14.9) (p = 0.002); 1.9 for NSVT (0.7 to 5.0) (p = 0.18) and 2.9 for LVWT (1.1 to 7.1) (p = 0.03). Patients with no risk factors (n = 203) had an estimated six-year SD-free survival rate of 95% (95% CI 91% to 99%). The corresponding six-year estimates (with 95% CIs) for one (n = 122), two (n = 36) and three (n = 7) risk factors were 93% (87% to 99%), 82% (67% to 96%) and 36% (0% to 75%), respectively. Patients with two or more risk factors had a lower six-year SD survival rate (95% CI) compared with patients with one or no risk factors (72% [56% to 88%] vs. 94% [91% to 98%]) (p = 0.0001).
CONCLUSIONS
This study demonstrates that patients with multiple risk factors have a substantially increased risk of SD sufficient to warrant consideration for prophylactic therapy. 相似文献
DESIGN: A population-based case-control study. SETTING: Villages in Palitana taluk of Bhavnagar district, Gujarat, India.
SUBJECTS AND METHODS: An interviewer-administered food frequency questionnaire, developed and validated for this population, was used to estimate nutrient intake in blinded, house-to-house interviews. Among 5018 male tobacco users, 318 were diagnosed as cases. An equal number of controls matched on age (±5 years), sex, village, and use of tobacco were selected.
MAIN OUTCOME MEASURES: Odds ratios (OR) from multiple logistic regression analysis controlling for relevant variables (type of tobacco use and economic status).
RESULTS: A protective effect of fibre was observed for both oral submucous fibrosis (OSF) and leukoplakia, with 10% reduction in risk per g day
CONCLUSION: In addition to tobacco use, intake of specific nutrients may have a role in the development of oral precancerous lesions. 相似文献