14 research outputs found
Identification of conservation priorities for and threats to Palouse grassland and canyon grassland remnants in Idaho, Washington, and Oregon /
no.98-1
Nationwide inâhospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany
Background
The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue.
Methods
All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as inâhospital mortality after a documented postoperative complication) for severe postoperative complications were determined.
Results
Some 64â349 patients were identified. The overall inâhouse mortality rate was 3·9 per cent. The crude inâhospital mortality rate ranged from 5·3 per cent in very lowâvolume hospitals to 2·6 per cent in very highâvolume centres, with a distinct trend between volume categories (Pâ<â0·001). In multivariable logistic regression analysis using hospital volume as random effect, very highâvolume hospitals (53 interventions/year) had a riskâadjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline inâhouse mortality rate in very lowâvolume hospitals (6 interventions per year) (Pâ<â0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; Pâ=â0·010).
Conclusion
Patients who had rectal cancer surgery in highâvolume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in lowâvolume hospitals
Nationwide in-hospital mortality following colonic cancer resection according to hospital volume in Germany
Background:
Colonic cancer is the most common cancer of the gastrointestinal tract. The aim of this study was to determine mortality rates following colonic cancer resection and the effect of hospital caseload on in-hospital mortality in Germany.
Methods:
Patients admitted with a diagnosis of colonic cancer undergoing colonic resection from 2012 to 2015 were identifed from a nationwide registry using procedure codes. The outcome measure was in-hospital mortality. Hospitals were ranked according to their caseload for colonic cancer resection, and patients were categorized into five subgroups on the basis of hospital volume.
Results:
Some 129 196 colonic cancer resections were reviewed. The overall in-house mortality rate was 5â
8 per cent, ranging from 6â
9 per cent (1775 of 25 657 patients) in very low-volume hospitals to 4â
8 per cent (1239 of 25 825) in very high-volume centres (P < 0â
001). In multivariable logistic regression analysis the risk-adjusted odds ratio for in-house mortality was 0â
75 (95 per cent c.i. 0â
66 to 0â
84) in very high-volume hospitals performing a mean of 85â
0 interventions per year, compared with that in very low-volume hospitals performing a mean of only 12â
7 interventions annually, after adjustment for sex, age, co-morbidity, emergency procedures, prolonged mechanical ventilation and transfusion.
Conclusion:
In Germany, patients undergoing colonic cancer resections in high-volume hospitals had with improved outcomes compared with patients treated in low-volume hospital
Breeding improves wheat productivity under contrasting agrochemical input levels
The world cropping area for wheat exceeds that of any other crop, and high grain yields in intensive wheat cropping systems are essential for global food security. Breeding has raised yields dramatically in high-input production systems; however, selection under optimal growth conditions is widely believed to diminish the adaptive capacity of cultivars to less optimal cropping environments. Here, we demonstrate, in a large-scale study spanning five decades of wheat breeding progress in western Europe, where grain yields are among the highest worldwide, that breeding for high performance in fact enhances cultivar performance not only under optimal production conditions but also in production systems with reduced agrochemical inputs. New cultivars incrementally accumulated genetic variants conferring favourable effects on key yield parameters, disease resistance, nutrient use efficiency, photosynthetic efficiency and grain quality. Combining beneficial, genome-wide haplotypes could help breeders to more efficiently exploit available genetic variation, optimizing future yield potential in more sustainable production systems