BACKGROUND

Severe postoperative acute respiratory failure (PARF) is potentially life-threatening. However, risk factors for severe PARF and mortality associated with severe PARF requiring corticosteroids remain unclear. The objectives of this study was to elucidate the occurrence and risk factors of severe PARF and in-hospital mortality after severe PARF.

METHODS

We utilised the Diagnosis Procedure Combination database, a national inpatient database in Japan, to retrospectively extract data on adult patients who underwent thoracic or abdominal surgery under general anaesthesia from April 2012 to March 2013. We performed a multivariable logistic regression analysis for the occurrence of severe PARF, defined by patients who required corticosteroid pulse therapy after surgery.

RESULTS

Among 607,079 patients who met the inclusion criteria, 553,106 underwent abdominal surgery and 53,973 underwent thoracic surgery. A significantly lower proportion of patients underwent corticosteroid pulse therapy in the abdominal than thoracic surgery group (0.2% vs. 1.0%, respectively; p < 0.001). The occurrence of severe PARF requiring corticosteroid pulse therapy was significantly associated with male sex, poor activities of daily living at admission, a longer duration of anaesthesia, thoracic surgery, and preoperative interstitial pneumonia. The mortality in patients who required corticosteroid pulse therapy were 34.2% and 36.7% in the abdominal and thoracic surgery groups, respectively (p = 0.292).

CONCLUSIONS

This large-scale study demonstrated significant risks of the occurrence of severe PARF requiring corticosteroid pulse therapy. Poor clinical outcomes were observed in association with severe PARF.

BACKGROUND

A recent large randomized controlled study suggested that albumin administration may reduce mortality in patients with septic shock. However, it remains unclear whether albumin should be used for initial resuscitation only without subsequent supplementation. The present study aimed to assess whether intravenous albumin infusion for initial resuscitation without subsequent supplementation is associated with reduced mortality in patients with septic shock using a national inpatient administrative claims database.

METHODS

In this retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2016, we identified patients with septic shock who received ≥3000 mL of total fluids on day 1 after the start of noradrenaline. We defined patients who received ≥75 g of albumin within 2 days after the start of noradrenaline as the albumin group and other patients as the control group. We performed one-to-one propensity-score matching analyses to analyze the associations of albumin administration with 28-day and 90-day mortality.

RESULTS

We identified 85,563 eligible patients during the 69-month study period. Of these, 6888 patients (8.1%) were allocated to the albumin group. After propensity-score matching, no significant differences were seen between the two groups for 28-day mortality (relative risk 0.95, 95% confidence interval 0.88–1.02) and 90-day mortality (relative risk 0.97, 95% confidence interval 0.92–1.03).

CONCLUSIONS

Intravenous albumin for initial resuscitation without subsequent supplementation was not significantly associated with reduced short-term mortality in patients with septic shock. Intravenous albumin for initial resuscitation only may therefore be ineffective.

BACKGROUND

It is unknown which medical diagnoses are strongly associated with long-term care needs certification.

METHODS

We conducted a case-control study using linked medical and long-term care data from two Japanese cities. The participants were aged ≥75 years, without any previous long-term care needs certification, and had at least one medical insurance claim record during a period between April 2013 and March 2015 in City A and between April 2013 and November 2016 in City B. Cases were newly certified people for long-term care needs during the study period, whereas controls (matched on age category, sex, city, and calendar date) were randomly selected in a 1:4 ratio. We conducted multivariable conditional logistic regression analyses to estimate the association between 22 categories of medical diagnoses recorded in the past six months and new (i.e., first ever) long-term care needs certification.

RESULTS

Among 38,338 eligible people, 5,434 (14.2%) newly received long-term care needs certification. The adjusted odds ratio (95% confidence interval) was largest for femur fractures, 8.80 (6.35–12.20), followed by dementia, 6.70 (5.96–7.53), pneumonia, 3.72 (3.19–4.32), hemorrhagic stroke, 3.31 (2.53–4.34), Parkinson’s disease, 2.74 (2.07–3.63), and other fractures, 2.68 (2.38–3.02). A restricted analysis to more severe outcome (care need levels 2 to 5), sensitivity analysis to use different periods for exposure definition, and separate analysis by city showed consistent results.

CONCLUSIONS

Among a range of recorded medical diagnoses, fractures (especially femur fractures), dementia, pneumonia, hemorrhagic stroke, and Parkinson’s disease were strongly associated with long-term care needs certification.

BACKGROUND

Previous studies have suggested that haptoglobin may be beneficial for preventing acute kidney injury (AKI) after severe burns. Although haptoglobin has been approved for the treatment of haemoglobinuria and subsequent AKI in Japan, robust evidence for this is lacking. We examined whether haptoglobin may be effective in preventing AKI requiring renal replacement therapy among patients with severe burns.

METHODS

We performed propensity score-matched analyses of the Japanese nationwide Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index ≥ 10) whose data were recorded from 1 July 2010 to 31 March 2013. We compared patients who were administered haptoglobin within 2 days of admission (haptoglobin group) and those who were not administered haptoglobin (control group). The main outcomes were: requirement for renal replacement therapy during admission, 28-day in-hospital mortality, length of hospital stay and ventilator-free days.

RESULTS

Eligible patients (n = 3223) from 618 hospitals were categorized into either the haptoglobin group (n = 263) or the control group (n = 2960). Propensity score matching created a matched cohort of 185 pairs with and without haptoglobin. There were no significant differences between the propensity score-matched groups in terms of the proportion of patients requiring renal replacement therapy (control vs haptoglobin, 25.9% vs 31.9%; p = 0.25), ventilator-free days (13 vs 6 days, p = 0.95), length of hospital stay (38 vs. 27, p = 0.45) and 28-day mortality (42.7% vs 46.5%, p = 0.53).

CONCLUSIONS

Our results suggest that haptoglobin use is not associated with reduced requirement for renal replacement therapy, increased ventilator-free days, length of hospital stay, or reduced 28-day mortality in patients with severe burns.