Slide Session : OS-HEM-02 ; Hematology : Incidence and Hospital Mortality of Venous Thrombo-embolic Disease Among Clinical and Surgical Inpatients

( Maria Lourdes Posadas Martinez ),( Fernando Javier Vazquez ),( Fernan Gonzalez Bernaldo De Quiros ),( Liliana Paloma Rojas ),( Gabriel Dario Waisman ),( Diego Hernan Giunta ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Venous thromboembolism (VTE) is the most common cause of preventable mortality in hospitalized patients. On plus, pulmonary embolism (PE) is responsible for 5-10% of all hospital deaths. Objective: To estimate the incidence density (ID) and hospital mortality of VTE among clinical and surgical inpatients. Methods: Prospective cohort, during a period of 7 years, of incident cases of VTE, PE, and deep venous thrombosis (DVT), in patients of 17 years and older, hospitalized at the internal medicine and surgery department of a tertiary care hospital in Buenos Aires. Fatality rate of patients with VTE was calculated. Results: 2042 episodes of VTE were registered. Sixty two percent (1258) were patients from the Internal Medicine Service: 635 cases (95%, CI:601-671) presented VTE, 446 cases (95%, CI:418-476) presented DVT and 286 cases (95% CI:264-311) presented PE per 1000 person-days of hospitalization. For patients hospitalized at surgery department: 102 cases (95%, CI:96-110), 83 (95%, CI: 77-90) and 31 cases (95%, CI: 27-35) per 1000 person-days of hospitalization presented VTE, DVT and PE respectively. The VTE represented between 3 to 9 % of hospital deaths, it increases with age independently of being clinical or surgical inpatients. Conclusions: In Argentina, there are few data of incidences of VTD and hospital mortality in patients with VTE. This information may be important when assessing the need for resources for prevention, diagnosis and treatment in hospitals.

Poster Session : PS 0308 ; Geriatrics : HIP Fracture Prognosis in Patients with and Without Hyponatremia

( Nora Angelica Fuentes ),( Diego Hernan Giunta ),( Cristina Maria Elizondo ),( Fernan Gonzalez Bernaldo De Quiros ),( Gabriel Dario Waisman ),( Juan Carlos Ayus ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Hip Fracture (HF) is a leading cause of morbidity and mortality in elderly. Related complications are cardiovascular (CVD), sepsis and venous thromboembolism (VTE), deep venous thrombosis (DVT) and pulmonary embolism (PE). In recent studies, chronic hyponatremia was observed to be an independent risk factor for hip fracture, nevertheless there is no evidence on prognosis of these patients compared to patients without hyponatremia. Objective: To compare the prognosis and complications of HF in normonatremic patients (N) and hyponatremic patients (H). Methods: Retrospective cohort of hospitalized patients with HF, followed up to 30 days after diagnosis, at Hospital Italiano of Buenos Aires. Presence of complications (sepsis, DVT, PE, and CVD), hospital length of stay, mortality and readmission were evaluated. Results: 1571 patients were included, 76, 7% (1205) for N and 23, 3% (366) for H. Most patients were female, 82. 5% and 79. 8% for H and N respectively. H were older, 85 vs. 82 years (p<0. 001). Sepsis was the most frequent complication for H (OR 1. 7, 95% CI: 1. 13-2. 6). Length of stay was 7 days vs. 8 days (p=0. 053) for N and H. Readmissions were 12. 9% for N vs. 15. 8% for H (p=0. 14). Hospital mortality was minor for N than for H (14. 7% vs. 19. 9%; p=0. 016), crude OR was 1. 45 (1. 07-1. 96) and adjusted OR was 1. 15 (0. 84-1. 6). Survival was higher for N than for H (p<0. 001). Crude hazard ratio (HR) of death for H compared to N was 1. 8 (1. 4-2. 35) and adjusted HR was 1. 45 (1. 1-1. 9). Conclusions: Hyponatremic patients have higher risk of sepsis, hospital length of stay and mortality. Thus hyponatremia could represent a marker of severity of underlying diseases or be a consequence of treatments during the surgical procedures, it could serve as alert for potential risk on outcome of these patients.

Poster Session : PS 0321 ; Hematology : Thromboembolism in Neurosurgical Patients: A Retrospective Cohort

( Maximiliano Toscano ),( Maria Lourdes Posadas Martinez ),( Pablo Marcelo Ajler ),( Maria Victoria Franco ),( Maria Teresa Garcia Botta ),( Ezequiel Goldschmidt ),( Fernan Gonzalez Bernaldo De Quiros 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE represents the fi rst cause of preventable morbidity and mortality in neurosurgery, these patients have many additional risk factors for VTE, but thromboprophylaxis is discussed for threatened complications. Estimated annual incidence in the United States is 600, 000 cases, with a mortality of nearly 17% at 3 months after diagnosis. Objetive: To estimate the incidence of postoperative VTE in patients with neurosurgery and to describe thrombophylactic measures, assigned treatment and associated complications. Methods: Retrospective cohort of all patients (=17 years) who underwent a neurosurgical procedure from January 2010 to January 2012. All patients were followed up to 90 days to evaluate the presence of VTE and/or death. Baseline characteristics, thromboprophylaxis, treatment for VTE and complications were evaluated. Results: During two years, 321 patients met the inclusion criteria. VTE incidence was 3. 1% (10 cases, 95% CI:1. 2%-4. 9%), 5 patients developed DVT, the other half developed both DVT and PE. 52% were female, median age was 55 (RIC 35-66) years. From the total of patients, 71% (229) received thromboprophylaxis, from which 58% implemented mechanical thromboprophylaxis and 42% received associated pharmacologic prophylaxis. 4 of the 10 patients with DVT were receiving prophylaxis at the time of the event. Not receiving thromboprophylaxis increased 1. 5 times (95%, CI:0. 95-2. 38, p=0. 001) the risk of presenting VTE that in those who received thromboprophylaxis. The risk of developing PE was 4 times (95%, CI:0. 73-22%, p=0. 001) bigger in those who didn´t receive thromboprophylaxis. 80% of patients received treatment for VTE: anticoagulants (4), thrombolytics and anticoagulants (1), thrombolytics (1), thrombolytics and fi lter (1) and 1 received fi lter and anticoagulation. For complications, no ETV patients died, one required hospitalization and 6. 9% (22) had major bleedings. Conclusions: VTE remains an important complication in neurosurgical patients.

Poster Session : PS 0364 ; Epidemiology and Public Health : Association of Nonattendance and Emergency Assessments, Emergency Hospitalization and Mortality

( Diego Hernan Giunta ),( Analia Judith Baum ),( Bruno Rafael Boietti ),( Nora Angelicafuentes ),( Carolina Gabay ),( Fernan Gonzalez Bernaldo De Quiros ),( Maria Florencia Grande Ratti ),( Daniel Rob 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: Nonattendance to scheduled outpatient appointments (SOA) produces ineffi ciency and discontinuity in care, although associated impact on mortality is unknown. Objetive: Evaluate association between SOA in primary care with emergency assessments (EA), emergency hospitalization (EH) and mortality (M) throughout a year. Methods: Retrospective cohort of adults affi liated to Hospital Italiano, with at least one SOA during 2012. We included all patients beginning from the last SOA of 2012 and followed them throughout a year, describing the events of EA, EH and M. We measured the number of SOA and the nonattendance proportion at the previous year before inclusion to the cohort. We used a Cox proportional hazards regression model, to estimate crude and adjusted Hazard Ratios (HR) and 95% confi dence interval. Results: 117327 patients were included, with a median age of 59 years (IQR:34), with a female frequency of 63. 3% (74300). Median of SOA was 8 appointments (IQR 9), the median of the nonattendance proportion of each patient was 28. 6% (IQR 39). 26% of patients had a proportion of nonattendance of 50% or more. EA was 13. 5% (15858); EH was of 3% (3551); and mortality was 1. 6% (1853) during follow up. Crude HR for each 10% increase in nonattendance proportion was 1. 031 (95%, IC:1. 025- 1. 037, p<0, 001) for EA; 1, 012 (95%, IC:1-1. 025, p=0. 051) for EH; and 1. 028 (95%, IC:1. 011-1, 045, p<0, 001) for M. Adjusted HR (by sex, age, diabetes, hypertension, cancer and coronary disease) for each 10% increment in nonattendance proportion was 1. 010 (95%, IC:1. 004-1. 017, p<0, 001);1. 099 (95%, IC:1. 084-1. 113, p<0, 001); and 1. 125 (IC95% 1, 105-1, 145, p<0, 001) for EA, EF and M respectively. Conclusions: Even though the nonattendance proportion effect on EA, EH and M is moderate, it could be relevant as a prognostic factor in high risk patients subgroups.