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July 27, 2010 — Embargoed ContentJAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives of 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. JAMA NEWS RELEASES
Complete Table of Contents
JAMA REPORT (VIDEO SCRIPT)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. TV Note: This week's JAMA Report video is on hospital complication rates of bariatric surgery. The report will be fed Tuesday, July 27, from 9:00 - 9:15 a.m. ET and 2:00 - 2:15 p.m. ET, on Galaxy 28 (C-Band), Transponder 15, downlink frequency: 4000 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA. The JAMA Report video is also now available on Pathfire every Tuesday, in VNF Provider A. Please look for the JAMA Report tab. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3:00 P.M. (CT), Tuesday, July 27, 2010
Late Preterm Births Associated With Increased Risk of Respiratory Illnesses
CHICAGO—An analysis of more than 200,000 deliveries finds that compared to infants born at full term, those born between 34 weeks and 37 weeks are more likely to have severe respiratory illness, and this risk decreases with each added week of gestational age during the late preterm period, according to a study in the July 28 issue of JAMA. Late preterm birth (34 0/7 to 36 6/7 weeks' gestation) accounts for 9.1 percent of all deliveries and three-quarters of all preterm births in the United States. Considerable evidence suggests that short-term illnesses are prevalent; however, much of the supporting data for this evidence is more than a decade old or drawn from small populations, according to background information in the article. Judith U. Hibbard, M.D., of the University of Illinois at Chicago, and colleagues of the Consortium on Safe Labor, conducted a study to determine current rates of respiratory illness among late preterm births through analysis of recent data from a large group of late preterm infants. The study included collection of electronic data from 12 institutions (19 hospitals) across the United States on 233,844 deliveries between 2002 and 2008. Charts were abstracted for all neonates (newborns) with respiratory problems admitted to a neonatal intensive care unit (NICU), and late preterm births were compared with term births in regard to resuscitation, respiratory support, and respiratory diagnoses. Of 19,334 late preterm births, 7,055 (36.5 percent) were admitted to a NICU and 2,032 had respiratory compromise. Of 165,993 term infants, 11,980 (7.2 percent) were admitted to a NICU, 1,874 with respiratory illness. The researchers found that respiratory distress syndrome (RDS; an acute lung disease of the newborn) was the most common respiratory illness, occurring in 10.5 percent (n = 390) of 34-week deliveries, decreasing with gestational age to 0.3 percent (n = 140/41,764) at 38 weeks. Transient tachypnea (rapid breathing) of the newborn was the second most common morbidity at 6.4 percent (n = 236) at 34 weeks, reaching a low of 0.3 percent (n = 207/ 62,295) at 39 weeks. Also decreasing from 34 weeks were pneumonia, from 1.5 percent to 0.1 percent at 39 weeks and overall respiratory failure, from 1.6 percent to 0.09 percent at 40 weeks. The percentage of infants with various respiratory illnesses decreased significantly as gestational age increased until 39-40 weeks. Additional analysis found that for neonates born at 34 weeks, the odds of RDS were increased 40-fold and that risk decreased with each advancing week of gestation until 38 weeks. "Even at 37 weeks, the odds of RDS were still 3-fold greater than that of a 39- or 40-week birth. Similar patterns were seen for transient tachypnea of the newborn, pneumonia, standard or high-frequency ventilator requirements, and respiratory failure," the authors write.
"We suggest that future studies should focus on indications for late preterm birth. Only by more completely understanding reasons for rising rates of late preterm birth might clinicians be able to initiate salutary interventions to decrease neonatal respiratory morbidity. Improved pregnancy dating through early ultrasound confirmation of estimated due date may help prevent neonatal morbidity associated with erroneous delivery of a neonate that is actually at an earlier gestational age. Finally, a better understanding of the effect of mode of delivery on neonates may help with future interventions to decrease morbidity," the researchers conclude.
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3:00 P.M. (CT), Tuesday, July 27, 2010
Genetic Risk Score Associated With Breast Cancer Risk; Predictive of Type of Disease
CHICAGO—Women with higher risk scores that consisted of having certain genetic variants most strongly linked to breast cancer had an associated higher risk of breast cancer, with these scores also highly predictive of estrogen receptor-positive disease, according to a study in the July 28 issue of JAMA. "Findings from genome-wide association studies (GWAS), together with analyses of specific candidate polymorphisms [gene variations], have identified a number of variants that are definitely or probably associated with breast cancer risk. There is also increasing evidence that some genetic factors have different effects on different subtypes of breast cancer," the authors write. Gillian K. Reeves, Ph.D., of the Cancer Epidemiology Unit, University of Oxford, U.K., and colleagues conducted a study to analyze breast cancer risk, overall and by tumor subtype, in relation to 14 individual single-nucleotide polymorphisms (SNPs;) and a polygenic (relating to an inheritable character that is controlled by several genes at once) risk score. The study included 10,306 women with breast cancer (average age at diagnosis, 58 years) and 10,393 women without breast cancer, who in 2005-2008 provided blood samples for genotyping. The researchers estimated the per-allele odds ratio (OR) for individual SNPs and the cumulative incidence of breast cancer to age 70 years in relation to a polygenic risk score based on the 4, 7, or 10 SNPs most strongly associated with risk. The researchers found that the odds ratios for breast cancer were greatest for the SNPs FGFR2-rs2981582 and TNRC9-rs3803662 and, for these 2 SNPs, were significantly greater for estrogen receptor (ER)-positive than for ER-negative disease, both in the data of this study and in meta-analyses of other published data. The next strongest association was for 2q-rs13387042, for which the per-allele OR was significantly greater for bilateral than unilateral disease and for lobular than ductal tumors. "When the effects of the 7 SNPs most strongly associated with overall breast cancer risk in these data were combined using a polygenic risk score, the cumulative risk of breast cancer to age 70 years among women in the top fifth was twice that in the bottom fifth (8.8 percent vs. 4.4 percent). Both the relative and, particularly, the absolute difference was much greater for ER-positive disease (7.4 percent vs. 3.4 percent) than for ER-negative disease (1.4 percent vs. 1.0 percent)," the authors write. "In this large study including 10,306 women with breast cancer and 10,393 without the disease, we confirm that some of the more important common genetic variants for breast cancer have different effects on different tumor types."
"Certain established risk factors for breast cancer have similar, or even greater, effects on breast cancer incidence than the differences seen here between women in the highest vs. the lowest fifth of polygenic risk score. Indeed, our estimate of the cumulative incidence of breast cancer to age 70 years in women in the top fifth for polygenic risk score (8.8 percent) is similar to that for women in developed countries with one first-degree relative with breast cancer (9.1 percent), and considerably less than that for women with 2 affected first-degree relatives (15.4 percent). Furthermore, no interactions have been found between the effects of the genes investigated here and the other risk factors for breast cancer. Hence, as others have suggested, subdividing women on the basis of their polygenic risk is, at this stage, not a useful tool for population-based breast cancer screening programs but may be useful for understanding disease mechanisms," the researchers conclude.
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3:00 P.M. (CT), Tuesday, July 27, 2010
Study Examines Hospital Complication Rates of Bariatric Surgery
CHICAGO—An examination of hospital complication rates of bariatric surgery for more than 15,000 patients in Michigan finds that the frequency of serious complications is relatively low and is inversely associated with hospital and surgeon procedural volume, according to a study in the July 28 issue of JAMA. With rates of bariatric surgery increasing over the last decade, it has become the second most common abdominal operation in the United States. "Despite trends toward declining mortality rates, payers and patient advocacy groups remain concerned about the safety of bariatric surgery and uneven quality across hospitals," the authors write. Nancy J. O. Birkmeyer, Ph.D., of the University of Michigan, Ann Arbor, Mich., and colleagues studied perioperative outcomes of bariatric surgery in Michigan, including comparing complication rates by procedure and among hospitals and the relationship between procedure volume, hospital safety, and centers of excellence (COE) accreditation. Standards for COE accreditation vary somewhat between programs, but generally include minimum procedure volume standards, availability of specific protocols and resources for managing morbidly obese patients, and submission of outcomes data to a central registry. The study involved 25 hospitals, 62 surgeons statewide and data from a clinical outcomes registry. The researchers evaluated short-term morbidity in 15,275 Michigan patients undergoing 1 of 3 common bariatric procedures between 2006 and 2009, and used various analytic tools to assess variation in risk-adjusted complication rates across hospitals and the association with procedure volume and COE designation status. The researchers found that overall, 7.3 percent of patients experienced 1 or more perioperative complications, most of which were wound problems and other minor complications. Serious complications were most common after gastric bypass (3.6 percent), followed by sleeve gastrectomy (2.2 percent), and laparoscopic adjustable gastric band (0.9 percent) procedures. After adjustment for patient characteristics and procedure mix, rates of serious complications varied from 1.6 percent to 3.5 percent across hospitals. Infection was the most frequent type of surgical site complication (3.2 percent) and was most common among patients undergoing gastric bypass (4.4 percent) and sleeve gastrectomy (2.5 percent) procedures. Fatal complications occurred in 2 patients receiving laparoscopic adjustable gastric band (0.04 percent), 0 patients receiving sleeve gastrectomy, and 13 patients receiving gastric bypass (0.14 percent). "Risk of serious complications was inversely associated with average annual bariatric procedure volume. For surgeon volume, rates in the low-, medium-, and high-volume categories were 3.8 percent, 2.4 percent, and 1.9 percent, respectively. For hospital volume, adjusted rates of serious complications were 4.1 percent, 2.7 percent, and 2.3 percent in low-, medium-, and high-volume hospitals, respectively. Serious complication rates were about twice as high (4.0 percent) for low-volume surgeons at low-volume hospitals than for high-volume surgeons at high-volume hospitals (1.9 percent)," the authors write. Overall, adjusted rates of serious complications were similar among patients undergoing surgery at COE hospitals (2.7 percent) and among those undergoing surgery at non-COE hospitals (2.0 percent). The researchers note that the findings of this study may not be generalizable outside of the state of Michigan, but "believe that the results reported in this study represent the outcomes of bariatric surgery that are possible, but not necessarily those that are typical in community settings."
"These data may serve as useful safety performance benchmarks for hospitals performing bariatric surgery. We hope that they might also inform the debate about the effectiveness of various approaches to ensuring high-quality care for bariatric surgery patients."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3:00 P.M. (CT), Tuesday, July 27, 2010
Delirium in Elderly Patients Associated With Increased Risks of Death, Dementia, and Institutionalization
CHICAGO—A review and analysis of previous research indicates that delirium in elderly patients is associated with an increased risk of death, dementia, and institutionalization, independent of age, co-existing illnesses or illness severity, according to a study in the July 28 issue of JAMA. "Delirium is a syndrome of acutely altered mental status characterized by inattention and a fluctuating course. With occurrence rates of up to half of older patients postoperatively, and even higher in elderly patients admitted to intensive care units, delirium is the most common complication in hospitalized older people," the authors write. "Evidence suggests that delirium is associated with long-term poor outcome but delirium often occurs in individuals with more severe underlying disease." Joost Witlox, M.Sc., of the Medical Center Alkmaar, the Netherlands, and colleagues conducted an analysis of previous studies to assess the association between delirium and long-term poor outcomes in elderly patients while controlling for important confounders (other factors that can influence outcomes). The researchers identified 51 relevant articles. The primary analyses included only high-quality studies with statistical control for age, sex, comorbid (co-existing) illness or illness severity, and baseline dementia. The primary analysis showed that delirium was associated with an increased risk of death compared with controls after an average follow-up of 22.7 months. "Moreover, patients who had experienced delirium were also at increased risk of institutionalization and dementia," the authors write. Further analysis confirmed the strength of the results. "The results of this meta-analysis provide evidence that delirium in elderly patients is associated with an increased risk, of death, institutionalization, and dementia, independent of age, sex, comorbid illness or illness severity, and presence of dementia at baseline. Moreover, our stratified models confirm that this association persists when excluding studies that included in-hospital deaths and patients residing in an institution at baseline," the researchers write. The authors add that the results of this meta-analysis can be instrumental in patient care. "The low rate of survival and the high rates of institutionalization and dementia indicate that older people who experience delirium should be considered an especially vulnerable population."
"Future studies will have to establish what exact mechanisms are responsible for the long-term poor outcomes after delirium and whether clinical characteristics of delirium itself (e.g., duration or subtype) differentially influence prognosis. Moreover, clinical trials are needed to investigate whether the long-term sequelae associated with delirium can be averted."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
JAMA REPORTS
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BARIATRIC SURGERY COMPLICATIONS ASSOCIATED WITH LOW VOLUME HOSPITAL AND SURGEON PROCEDURES RATES
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