JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 21, 2005)
AGE ALONE INFLUENCES RISK OF DEATH AND DISEASE FOR OCTOGENARIANS AFTER HEART SURGERY
USE OF LAPAROSCOPIC PROCEDURE FOR GALLBLADDER REMOVAL VARIES WIDELY
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 21, 2005)
BODY POSITION AFFECTS SLEEP APNEA AMONG YOUNG CHILDREN
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 21, 2005
Media Advisory: To contact corresponding author Mary Pat Hendy, B.S., call Joe Kelley at 513-569-6702.
AGE ALONE INFLUENCES RISK OF DEATH AND DISEASE FOR OCTOGENARIANS AFTER HEART SURGERY
CHICAGO—Patients aged 80 and older have a higher risk of death and disease than younger patients after undergoing coronary artery bypass graft (CABG) surgery or valve surgery, and age alone influences these outcomes, according to a study in the November issue of Archives of Surgery, one of the JAMA/Archives journals.
There were 4.2 million Americans aged 85 or older in 2000, and this number is projected to increase to 8.9 million by 2030, according to background information in the article. Approximately 40 percent of all octogenarians have symptomatic cardiovascular disease. Previous observational studies have shown that octogenarians undergoing open heart surgery for CABG or valve replacement are at higher risk for postoperative death. But until recently, no large studies have determined whether age is an independent risk factor for disease and death in octogenarians undergoing open heart surgery.
W. Michael Johnson, M.D., of Good Samaritan Hospital, Cincinnati, and colleagues conducted an eight-year hospitalization cohort study to determine whether being an octogenarian is an independent risk factor for mortality, as well as for nine other measured outcomes. Data were collected on a consecutive sample of 7,726 patients undergoing coronary artery bypass grafting or valve surgery between October 1, 1993, and February 28, 2001. There were 522 octogenarians in the study sample. The researchers controlled for 16 potential confounding variables to isolate outcome differences according to age.
"...octogenarians were found to have a higher risk for death (72 percent higher), longer length of hospitalization (3 percent higher), and a higher risk for neurologic complications (51 percent higher); they were also more likely to undergo re-operation to treat bleeding (49 percent more likely)," the authors report.
There were no significant differences between octogenarians and patients under the age of 80 in regard to kidney, lung, or gastrointestinal tract complications, returns to intensive care, or intraoperative complications-such as heart attack, hemorrhage, and irregular heartbeat.
"Like other investigators, we found that octogenarians were at higher risk for postoperative death," the authors write. "However, our results show that after controlling for differences between octogenarians and non-octogenarians, age is an independent risk factor for morbidity and mortality."
The authors point to projections that an estimated 12 million Americans will swell the ranks of octogenarians by the year 2010, as the younger population ages and life expectancy rises. "An increasing number of octogenarians undergoing coronary revascularization or valve surgery are certain to strain an already burdened health care system," they assert.
"It is, therefore, incumbent on researchers to develop more refined algorithms to predict postoperative outcomes," the authors conclude. "As this study indicates, age should be considered a component of any such algorithm."
(Arch Surg. 2005;140:1089-1093. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 21, 2005
Media Advisory: To contact Chi Ming Lam, M.S., F.R.C.S., email lamcm{at}hkucc.hku.hk.
USE OF LAPAROSCOPIC PROCEDURE FOR GALLBLADDER REMOVAL VARIES WIDELY
CHICAGO—There is a wide variation in the use of laparoscopic surgery for gall bladder removal in Hong Kong hospitals, and use of this procedure is more likely at certain hospitals and among younger female patients operated on more recently, according to a study in the November issue of Archives of Surgery, one of the JAMA/Archives journals.
Laparoscopic cholecystectomy (LC, removal of the gallbladder by laparoscopy) is a well-established technique for the management of symptomatic gallstone disease. But acute cholecystitis (inflammation of the gallbladder) has been considered a relative, if not absolute, contraindication for LC because of the technical difficulties and a higher complication rate, according to background information in the article.
Chi Ming Lam, M.S., F.R.C.S., and colleagues with the Hospital Authority, Hong Kong, China, and the University of Hong Kong, investigated the variation in surgical treatment of acute cholecystitis in a stable population and the factors determining the use of LC in the emergency condition. They conducted a retrospective survey on 2,353 patients with pathologically proven acute cholecystitis who had gallbladder surgery at all public hospitals in Hong Kong from 1998 to 2002. The study reflected the practice of LC for acute cholecystitis in about 86 percent of the inpatient population in Hong Kong.
"The rate of using LC for acute cholecystitis increased by 30.4 percent from 1998 to 2002," the authors report. "We observed a wide variation in the use of LC for acute cholecystitis ranging from 3.7 percent to 92.9 percent." Certain factors, including the hospital, year of operation, and patient age were associated with increased rates of LC. "Young female patients from selected hospitals [operated on] recently are more likely to be treated with LC," they continue.
The authors point out that even though the laparoscopic approach has become the method of choice for elective gallbladder removal, conventional open cholecystectomy still remains the treatment of choice for acute cholecystitis for many surgeons-mainly because of concerns about bile duct injuries and an excessively high conversion rate (a procedure that begins using the laparoscopic technique, but then requires "converting" to an open laparotomy for gall bladder removal).
"The application of LC in the emergency condition is technically demanding and certainly needs to be performed by experienced laparoscopic surgeons," they assert.
"The present study demonstrated that, on a population basis, the use of LC for acute cholecystitis is increasingly popular among surgeons," the authors conclude. "More LCs for acute cholecystitis have been performed recently. In a relatively stable population, younger female patients in selected hospitals are more likely to have LC for acute cholecystitis."
(Arch Surg. 2005;140:1084-1088. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Sun C.Y. Research Foundation for Hepatobiliary and Pancreatic Surgery of the University of Hong Kong, Hong Kong, China.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 21, 2005
Media Advisory: To contact Kevin D. Pereira, M.D., call Shannon Rasp at 713-500-3304.
BODY POSITION AFFECTS SLEEP APNEA AMONG YOUNG CHILDREN
CHICAGO—Children aged three and younger who have a sleeping disorder known as sleep apnea show more respiratory disturbance when they sleep on their backs, according to a study in the November issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Obstructive sleep apnea syndrome (OSAS) is a serious medical problem affecting an estimated half a million children per year in the United States, according to background information in the article. Pediatric OSAS is most commonly caused by enlarged tonsils and adenoids. It is characterized by episodes of partial or complete upper airway obstruction that occur during sleep, including snoring, cyanosis (a bluish color of the skin and mucous membranes), and poor quality of sleep. Symptoms during the day can include mouth breathing, behavior problems, hyperactivity, and excessive daytime sleepiness. While research among adults has shown a significant decrease in OSAS episodes when patients avoid sleeping on their backs (the supine position), the issue of sleep position is not as well understood among children with OSAS.
Kevin D. Pereira, M.D., and colleagues at the University of Texas Health Science Center at Houston conducted a retrospective chart review to evaluate the association between body position and OSAS events during sleep in children aged three and younger. The study included 60 children who underwent polysomnography (PSG, the continuous recording of physiologic variables during sleep) to evaluate OSAS, and later had surgery to remove their tonsils and adenoid tissue, between December 1, 2000, and November 30, 2003. The PSGs were analyzed for data on the respiratory disturbance index (RDI, an index measuring respiratory events that disturb sleep), time spent in each body position during sleep, the number of apneic events in each position, oxygen saturation, and time spent in each stage of sleep.
The authors found there was an increase in the RDI with increased time spent in supine sleep. "The mean RDI increased from 5.6 to 8.5 when more than 50 percent of the time was spent in supine sleep," they write. "There was a further increase to 10.5 when supine sleep increased to 75 percent of the total sleep time." The most significant finding was that the RDI in the supine position was greater than in all other positions combined.
"The results of our study indicate that supine sleep does correlate with an increase in RDI as well as with OSAS in pediatric patients younger than three years," the authors write. "This finding is in contrast to previous studies that have demonstrated no correlation between sleep position and OSAS in children."
The authors urge clinicians who use PSG to diagnose and manage sleep disorders in children to take into consideration the variables that may affect the validity of the results. "Lack of adequate supine sleep may be an important factor in symptomatic children with normal sleep study results."
(Arch Otolaryngol Head Neck Surg. 2005;131:1014-1016. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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