Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study

Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients.A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact.Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37), pneumonia (odds ratio 2.01, 1.61 to 2.49), postoperative bleeding (odds ratio 1.35, 1.09 to 1.68) and septicemia (odds ratio 2.43, 1.85 to 3.21) without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability.Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients

Genetic and population studies of quantitative levels of adenosine triphosphate in human erythrocytes

The mean content of ATP in red cells of American Negroes is significantly less than the mean level in American Caucasians. This is compatible with the hypothesis that the quantitative level of ATP in red cells may be involved in selective processes related to falciparum malaria. There is no evidence of a sex effect on levels of ATP in either population. Family studies conducted in both populations indicate that the quantitative level of red cell ATP is at least partially inherited. Studies of a number of biochemical characteristics of red cells have been conducted in an effort to elucidate the mechanism of genetic and biochemical control of quantitative levels of erythrocytic ATP. These studies have been negative. Although other studies have demonstrated that thalassemia trait influences the level of red cell ATP, the presence of sickle cell trait or G-6-PD deficiency, the other two systems postulated to be involved in malaria protection, did not result in significant differences in mean red cell ATP content.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44114/1/10528_2004_Article_BF00487733.pd

Inheritance of quantitative expression of erythrocyte glucose-6-phosphate dehydrogenase activity in the Negro—a twin study

Studies have been conducted on eight sets of monozygous and nine sets of dizygous female Negro twins, both members of whom were heterozygous for G-6-PD deficiency. Twins were studied both by assay of erythrocytic G-6-PD activity and by the methemoglobin elution test (MET). The MET is a procedure which identifies histochemically cells with appreciable G-6-PD activity and permits accurate determination of the percentage of such cells in heterozygotes. Monozygous twins showed significantly less “within-pair” variation than dizygous twins with both the MET and G-6-PD assay.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44115/1/10528_2004_Article_BF00487735.pd