Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients

BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.

Neonatal Morbidity and Mortality at Hospital Saint Camille de Ouagadougou (HOSCO): A Study from 2017 to 2020

Introduction: Neonatal pathology remains a real public health problem in developing countries. In Burkina Faso, this mortality has declined over the last ten years but remains below compared to the Sustainable Development Goals, which is 12 per 1000 living births at most by 2030. This study aims to identify specific causes of neonatal morbidity and mortality and will contribute to the implementation of preventive and curative measures aimed at reducing neonatal mortality at HOSCO. Method: This was a retrospective study using the records and database of newborns hospitalized from January 1srt, 2017 to December 31srt, 2020. Using logistic regression, the factors associated with mortality were determined. Results: During the study period, 3020 newborns were hospitalized. Most newborns (83.71%) were referred by a peripheral health facility. The average age at admission was 0.3 days ± 0.9 and the sex ratio was 1.2. Prematurity was the leading cause of hospitalization (61.13%) followed by neonatal infection (38.34%) and neonatal suffering (23.88%). The mortality rate was 40.6% with 82.71% cases of death in the early neonatal period. The main causes of death were low birth weight (47.39%), respiratory distress (18.76%), neonatal suffering (17.37%) and neonatal infection (13.87%). Home delivery, gestational age 36 weeks, number of PNC 4, concept of resuscitation, Apgar at the 5th minute 7, birth weight 2000 g and >4000 g, respiratory distress, hypothermia, neurological disorders were factors associated with deaths. Conclusion: Neonatal mortality is influenced by both maternal and fetal factors and many of them are preventable.

Morbidity and Mortality during Anaesthesia in Patients with versus without Diabetes: Single-Centre Cohort Study

Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.

Morbidity and Mortality of Newborns in a Context of Limited Resources in Tombouctou, Mali

Introduction: Worldwide, 2.3 million children died in the first 20 days after birth in 2022, according to the WHO. In Mali, according to the sixth Demographic and Health Survey, the neonatal mortality rate was estimated at 33% live births in 2018. The Timbuktu region had the highest neonatal mortality rate in the country with 44%. The objective of this work was to study the causes of neonatal morbidity and mortality and related factors in the paediatrics department of Timbuktu hospital. Materials and method: This was a descriptive, cross-sectional study conducted from 1 January to 31 December 2023 in the neonatology unit of the paediatrics department of Timbuktu hospital, including all newborns admitted to hospital. Results: Our study took place over 12 months, during which 618 admissions were made to the paediatric ward, including 244 newborns, i.e. 39.48%. The majority of newborns (86.5%) were admitted in the first week of life. The mean age was 3 days, with a sex ratio of 1.1 for males. Weight under 2500 g was 54.1% for an average weight of 2372 g. The main mode of admission was transfer from the hospital maternity unit (62%). The main reasons for admission were acute foetal distress (27.9%) and prematurity (26.2%). The average age of the mothers was 24, with extremes of 15 and 49. The mothers were housewives (87.3%), uneducated and primiparous (59% and 36.5% respectively);only 40.2% had made more than 3 antenatal care visits. Newborns born by vaginal delivery accounted for 80.7% and those born by caesarean section for 19.3%. The risk of infection was present in 52.5% of cases. The three leading causes of hospitalisation were birth asphyxia (40.2%), neonatal infection (32.4%) and prematurity (25%). The mortality rate was 21.7%. The main causes of death were prematurity (39.6%), birth asphyxia (32.1%) and neonatal infection (24.5%). Conclusion: Neonatal morbidity and mortality remain a concern in Timbuktu. Despite the unfavourable security situation, morbidity and mortality indicators are close to those in some hospitals in Mali. The correct application of Essential Newborn Care and antenatal care remains a major challenge for the hospital and the Timbuktu region.

Perinatal Morbidity and Mortality Associated with Maternal Diabetes in the Neonatology Department of the Issaka Gazoby Maternity Hospital, Niamey, Niger

Introduction: The association of diabetes and pregnancy is associated with a significantly higher risk of perinatal morbidity and mortality. The aim of this study was to investigate the perinatal morbidity and mortality associated with maternal diabetes at the Issaka Gazoby Maternity Hospital in Niamey. Methodology: This was a prospective case-control study conducted from April to September 2021 at the Issaka Gazoby Maternity Hospital in Niamey. “Cases” were neonates born to diabetic mothers, and “controls” were neonates born to non-diabetic mothers. The main dependent variable was the occurrence of perinatal complications. Analysis was performed using Epi info software 7.2.1. Pearson’s Chi2 test or Fisher’s exact test were used (p Results: Of the 2,225 admissions during the study period, 31 newborns were born to diabetic mothers (1.4%). Diabetic mothers were 2.8 times more likely to have a history of abortion (67.7% vs. 28.6%;OR = 2.82;p = 0.001). Similarly, a history of macrosomia was found in 29.0% of diabetic mothers versus 9.5% of controls (OR = 2.15;p = 0.01). Macrosomia was also more common in newborns of diabetic mothers (38.7% vs. 9.5%;OR = 2.63;p Conclusion: The risks of ante- and perinatal complications such as abortion, fetal macrosomia and stillbirth, as well as neonatal pathological events (macrosomia and malformations) were greater in newborns of diabetic mothers.

Morbidity and Mortality Related to Infectious Diseases in the Roi Boudouin Paediatric Ward in Senegal

Introduction: Infant and child morbidity and mortality linked to infections remain a major concern in both developed and developing countries. The general objective was to determine the characteristics of hospital morbidity and mortality linked to infectious pathologies in the pediatric department of the King Baudouin hospital center in Dakar. Methods: This was a retrospective, descriptive and analytical study focusing on children hospitalized from January 1, 2018 to December 31, 2021 in the pediatric department of the King Baudouin hospital center in Dakar. Results: During the study period, 1474 children were hospitalized for an infectious pathology in the pediatric department. The sex ratio was 1.48. Children aged between one and twelve months represented 34.12%. Morbidity due to respiratory and digestive infections was 42.33% and 33.45%, respectively. Pediatric hospital mortality was 0.75% with a predominance noted in infants between 1 and 12 months (55.86%). Respiratory, digestive infections, sepsis and neurological infections were the main causes of death. Factors associated with mortality were age (1 to 12 months) with p Conclusion: Reducing infant and child mortality linked to infectious diseases remains a crucial challenge to address for improving children’s health. Early detection of related signs, prevention of infections, and adequate care and monitoring of infants and children can contribute to this reduction.

Morbidity and Mortality in the Emergency Department of the Albert Royer National Children’s Hospital Center Dakar: Prospective Study from January 1 to April 30, 2020

Introduction: Infant and child morbidity and mortality constitute a public health problem in Africa, particularly in Senegal. The objective of this work was to help identify the determinants this morbidity and mortality. Materials and Methods: A prospective study, over a 4-month period (January to April 2020). All patients aged 0 to 15 years, hospitalized for emergency reasons in the Albert Royer emergency department, were included. Mortality was analyzed according to sociodemographic data, the patient’s itinerary, transfer procedures, availability of emergency medications, diagnosis made during hospitalization and causes of death. The data were collected based on a protocol in an established file and analyzed by SPSS (Statistical Package for Science Social) software. Version 18. Results: 225 children in emergency situations were included. The age of our patients is between 0 and 15 years (minimum 0.23 months, maximum 191 months, average 47 months and standard deviation 54). Thus, emergencies represented 57.98% of the 388 hospitalizations. Seventy percent of patients were less than 60 months old with a male predominance (sex ratio 1.16), 2.22% were newborns and 27.11% were aged between 60 and 191 months). A total of 79 (35.1%) were transferred and only 57.4% received care before transfer. A total of 12 deaths were reported, representing a lethality of 5.3%. Only young age (less than 59 months, a mortality rate of 91.7%), cardiac decompensations, severe sepsis, and neonatal conditions were more associated with mortality. The majority of our deceased patients came from families with a low socio-economic level (83.3%). Conclusion: Pediatric emergencies are frequent and responsible for lethality and require the necessary efforts, particularly through parent education, the creation of emergency outpatient care units and, above all, the strengthening of the technical platform and therapeutic means.

Peri-Operative Morbidity and Mortality of Elderly Patients in Traumatology-Orthopedics in Bouaké

Introduction: Elderly subjects have physiological and clinical characteristics that make surgical management more complex and have a major impact on their prognosis. The primary objective of this study was to assess peri-operative hospital morbidity and mortality in the elderly. Secondary objectives were to identify factors predictive of death. Methods: This was a retrospective observational descriptive and analytical study carried out over 02 years, based on hospitalized patient records. It concerned patients aged 65 or over who had undergone surgery or for whom an indication for surgery had been given, all pathologies included. A total of 138 files were collected. The mean age was 74.15 years. Diabetes (n = 52;37.68%) and arterial hypertension (n = 38;27.54%) were the most common comorbidities. The reasons for hospitalization were mostly degenerative (n = 56;40.58%) and traumatic (n = 49;35.51%) pathologies. Preoperative delay, intraoperative and postoperative complications, hospital stay, evolution (mode of discharge), time of occurrence and presumed cause of death were studied. Univariate (p Results: The mean preoperative delay was 5.53 days (1 - 23). Intraoperative complications were mainly hemodynamic instability (n = 26, 18.8%). Postoperatively, the main complications were anemia (n = 62;48.44%) and glycemic imbalance (n = 28;21.86%). Average hospital stay was 13.4 days. Age (>75 years), the existence of comorbidities, degenerative pathologies, ASA score > 2, delay in treatment > 3 days, the occurrence of complications and the blood transfusion requirement were the independent predictors of the occurrence of death in the multifactorial analysis. Conclusion: Peri-operative morbidity in the elderly was influenced by age (>75 years), the existence of comorbidities, degenerative pathologies, ASA score > 2, time to treatment > 3 days, the occurrence of complications and the blood transfusion requirement.

Morbidity and Mortality of Acute Renal Failure in COVID-19 Patients in Intensive Care According to Waves/Variant: Case of the Grand Hôpital de l’Est Francilien Site de Meaux

Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the different epidemic waves, probably due to the genetic variant phenomenon of the virus. The aim of this study is to determine the morbidity and mortality of COVID-19 patients admitted with ARF to the intensive care unit of the Grand H?pital Est Francilien (GHEF) according to the waves and variants. Methods: Cross-sectional observational study of COVID-19 patients with ARF admitted to the intensive care unit of the GHEF site in Meaux covering the period from March 1st 2020 to December, 31st 2021. Per-hospitalisation and outcome data were collected and analysed with SPSS version 25.0 software using the Chi-square or Fischer’s exact test or Student’s t-test and logistic regression for p Results: A total of 86 patients were included. The mean age was higher (70 ± 8.5) in patients in the fourth wave than in the other waves (p = 0.015), with male predominance in all waves without significant difference. Co-morbidities: hypertension, diabetes, heart disease, dyslipidaemia and arrhythmia complete with fibrillation were present in all waves. The majority of patients were classified as KDIGO 1 for the different waves (1st: 61.9%, 2nd: 86.5%, 3rd: 80%, and 4th: 75%), with the same trend according to variant (alpha: 80%, beta: 75%, delta: 81.3%, omicron: 75%). Mortality by the wave was: 1st: 28.5%, 2nd: 37.5%, 3rd: 23% and 4th: 11%) and by variant: alpha: 24.2%, beta: 44.8%, delta: 20.7%, omicron: 10.3%). Overall mortality was 33.7%. Case fatality was higher in the fourth wave. Hypertension, shock, failure to recover renal function, acute lung oedema, ventilator-associated lung disease and hyperkalaemia were factors associated with mortality (p Conclusion: Acute renal failure is common in COVID-19 patients admitted to the intensive care unit, and mortality is not negligible. The beta variants and the second wave presented more cases of renal impairment, although the mechanism is still unknown. Further studies are needed to understand this mechanism and perhaps to be able to identify the cause.

Perinatal Morbidity, Mortality, and Neurodevelopmental Outcomes of Neonates with Fetal Growth Restriction

Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.

Proton pump inhibitors and all-cause mortality risk among cancer patients

BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.

Convergence of COVID-19 and recurrent stroke:In-hospital mortality risks explored

This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.

Morbidity and Mortality of Nosocomial Infection after Cardiovascular Surgery： A Report of 1606 Cases

Nosocomial infection （NI） is one of the most significant complications arising after open heart surgery, and leads to increased mortality, hospitalization time and health resource allocation. This study investigated the morbidity, mortality, and independent risk factors associated with NI following open heart surgery. We retrospectively surveyed the records of 1606 consecutive cardiovascular surgical patients to identify those that developed NI. The NI selection criteria were based on the Centers for Disease Control and Prevention （CDC） guidelines. The term NI encompasses surgical site infection （SSI）, central venous catheter-related infection （CVCRI）, urinary tract infection （UTI）, respiratory tract infection and pneumonia （RTIP）, as well as other types of infections. Of 1606 cardiovascular surgery patients, 125 developed NI （7.8%, 125/1606）. The rates of NI following surgery for congenital malformation, valve replacement, and coronary artery bypass graft were 2.6% （15/587）, 5.5% （26/473） and 13.6% （32/236）, respectively. The NI rate following surgical repair of aortic aneurysm or dissection was 16.8% （52/310）. Increased risk of NI was detected for patients with a prior preoperative stay 〉3 days （OR=2.11, 95% CI=1.39-3.20）, diabetes （OR=2.00, 95%=CI 1.26-3.20）, length of surgery 〉6 h （OR=2.26, 95% CI=1.47-3.47）, or postoperative cerebrovascular accident （OR=4.08, 95% CI=1.79-9.29）. Greater attention should be paid toward compliance with ventilator and catheter regulations in order to decrease NI morbidity and mortality following cardiovascular procedures.

Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery

AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.

Emergency laparotomy in octogenarians: A 5-year study of morbidity and mortality

AIM: To determine the morbidity and mortality associated with emergency laparotomy for a clinically acute abdomen in patients aged ≥ 80 years. METHODS: In this retrospective audit, octogenarians undergoing emergency laparotomy between 1st January 2005 and 1 st January 2010 were identified using the Galaxy Theatre System. Patients undergoing abdominal surgery through groin crease incisions or Lanz or Gridiron incisions were excluded. Also simple appendectomies were excluded. All patients were aged 80 years or more at the time of their surgery. Data were obtained using casenote review with a standardised proforma to determine patient age, American Society of Anesthesiologists (ASA) grade, indications for surgery, early (within 30 d) and late (after 30 d) complications, mortality and length of stay. Data were inserted into a Microsoft Excel spreadsheet and analysed. RESULTS: One hundred patients were identified from the database (Galaxy) as having undergone emergency laparotomy. Of those, 55 underwent the procedure for intestinal procedures and 37 for secondary peritonitis.There was a 2:1 female predominance; average age 85 and ASA grade 3. Bowel resection was required in 51 out of the 100 patients and 22 (43%) died. Other procedures included appendicectomy, adhesiolysis, repair of AAA graft leak and colostomies for the pathological process resulting in an acute abdomen. Twelve of 100 patients (12%) suffered intra-operative complications, including splenic and bowel-serosal tears. Seventy patients (70%) had postoperative complications including myocardial infarction, wound infection, haematoma and sepsis. Overall mortality was 45/100 patients (45%). The major causes of death were sepsis (19/45 patients, 42%), underlying cancer (13/45 patients, 29%); with others including bowel obstruction (2/45 patients, 4%), myocardial and intestinal ischaemia and dementia. CONCLUSION: Emergency laparotomy in octogenarians carries a significant morbidity and mortality. In particular, surgery requiring bowel resection has higher mortality than without resection.

Risk factors for operative morbidity and mortality in gastric cancer patients undergoing total gastrectomy

AIM： To study the risk factors for morbidity and mortality following total gastrectomy. METHODS： We retrospectively reviewed the records of 125 consecutive patients who underwent total gastrectomy for gastric cancer at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2003 and March 2008. RESULTS： The overall morbidity rate was 20.8% （27 patients） and the mortality rate was 3.2% （4 patients）. Morbidity rates were higher in patients aged over 60 [odds ratio （OR） 4.23 （95% confidence interval （CI） 1.09 to 12.05）], with preoperative comorbidity [with vs without, OR 1.25 （95% CI 1.13 to 8.12）], when the combined resection was performed [combined resection vs total gastrectomy only, OR 2.67 （95% CI 1.58 to 5.06）]. CONCLUSION： Age, preoperative comorbidity and combined resection were with the rate of morbidity gastric cancer. independently associated after total gastrectomy for

Mortality and morbidity in necrotizing pancreatitis managed on principles of step-up approach:7 years experience from a single surgical unit

AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.

Morbidity and Mortality of Inpatients in the Department of Infectious Diseases of the University Hospital of Bobo-Dioulasso, Burkina Faso

Background: Infectious Diseases are responsible for nearly 17 million annual deaths worldwide. Burkina Faso, like the majority of poor countries, remains vulnerable to infectious diseases. The objective of the present study was to analyze the profile of inpatients, including the mortality and causes of death, in the Infectious Diseases Department of SourôSanou teaching hospital (Bobo-Dioulasso, Burkina Faso). Methods: We carried out a cross-sectional study based on medical records of all inpatients from 2011 to 2015. Results: We included 1169 patients. The gender ratio was 0.8. The age group 30 to 39 was more represented (30.2%) as well as housewives and farmers (73.7%). Over one-thirds of the patients (35.3%) were consulted within an average of 7 days. The most common reason for consultation was fever (65.1%). Around 62.0% of inpatients were infected by the Human Immunodeficiency Virus (HIV). Digestive diseases ranked first (21.8%) followed by nervous system disorders (19.4%) and tuberculosis (17.8%). Overall morbidity rate was 31.3%. About 42% were admitted to the emergency ward while 83.3% already arrived with poor health condition. And 82.1% of deaths occurred on pathological grounds of which 66.7% were related to HIV. Main causes of death included nervous system diseases (28.6%), tuberculosis (21.9%) and gastrointestinal diseases (18.3%). Conclusion: Infectious diseases remain a major public health issue. Further efforts are needed to improve their management in Burkina Faso.

Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia

BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.