Pitfalls in nonrandomized outcomes studies: the case of incidental appendectomy with open cholecystectomy

Article Abstract:

Nonrandomized comparisons of postoperative outcomes can be misleading, if not statistically adjusted for confounding factors. Researchers used the test case of incidental appendectomy with open cholecystectomy to evaluate clinical validity of nonrandomized administrative data. Cholecystectomy is the surgical removal of the gallbladder. Researchers reviewed a total of 199,445 patient cases of open cholecystectomy, of which 7,846 cases had incidental appendectomies. Without adjusting for confounding factors, comparisons showed an unlikely reduction of in-hospital mortality and shorter lengths of stay after cholecystectomy when incidental appendectomy was performed. However, when the analysis was restricted to lower-risk subgroups to adjust for confounding factors such as older age, comorbid conditions, and malignant gallbladder disorders, incidental appendectomy was associated with a small increase in adverse postoperative outcomes and a marked increase in complications.

Analysis, Cholecystectomy, Outcome and process assessment (Health Care), Outcome and process assessment (Medical care), Appendectomy

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Pulmonary artery catheterization: can there be an integrated strategy for guideline development and research promotion?

Article Abstract:

A strategy for developing detailed indications for the use of pulmonary artery catheterization (PAC) in critically ill patients is presented. PAC, which is used to monitor blood flow, is commonly used in intensive and coronary care units, but its effectiveness has been questioned. Routine use of PAC is expensive, and many physicians are poor at inserting, calibrating and interpreting information from PAC. Most studies on PAC have been too small to determine its usefulness, when it should be used and which patients it will benefit the most. Four studies found that use of PAC was associated with lower death rates while two found PAC was not associated with any improvements in survival. To develop guidelines for the use of PAC, a panel of experts should rank the appropriateness of the procedure given various clinical indicators and scenarios. Using these guidelines, patients could then safely be chosen to participate in the clinical studies needed.

Usage, Surgery, Arterial catheterization, Pulmonary artery

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The spectrum of septic encephalopathy: definitions, etiologies, and mortalities

Article Abstract:

The use of different scoring systems to assess septic encephalopathy could account for the differences in the incidence of this disorder reported in the literature. Septic encephalopathy is a mental disorder caused by bacterial infection in the blood. Researchers used three different scoring systems to assess the severity of encephalopathy in 50 patients with sepsis. The scoring systems included altered mental status, a clinical score of encephalopathy and the Glasgow Coma Score. Mortality was higher in patients with encephalopathy. Depending on which scoring system was used to diagnose encephalopathy, the incidence of encephalopathy ranged from 50% to 62%. Mortality rates in encephalopathic patients ranged from 33% to 39%. Patients diagnosed as having encephalopathy by altered mental status or clinical score were more likely to have bacterial infection in the blood. No unique metabolic abnormality was found in patients with encephalopathy.

Patient outcomes, Mortality, Bacteremia, Encephalopathy

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