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Perioperative risk model

J Daniel Muehlschlegel, Peter S Burrage, Jennie Yee Ngai, Jordan M Prutkin, Chuan-Chin Huang, Xinling Xu, Sanders H Chae, Bruce A Bollen, Jonathan P Piccini, Nanette M Schwann, Aman Mahajan, Marc Ruel, Simon C Body, Frank W Sellke, Joseph Mathew, Ben O'Brien
Postoperative atrial fibrillation (poAF) is the most common adverse event after cardiac surgery and is associated with increased morbidity, mortality, and hospital and intensive care unit length of stay. Despite progressive improvements in overall cardiac surgical operative mortality and postoperative morbidity, the incidence of poAF has remained unchanged at 30%-50%. A number of evidence-based recommendations regarding the perioperative management of atrial fibrillation (AF) have been released from leading cardiovascular societies in recent years; however, it is unknown how closely these guidelines are being followed by medical practitioners...
January 2019: Anesthesia and Analgesia
Andrew D Krahn, Yves Longtin, François Philippon, David H Birnie, Jaimie Manlucu, Paul Angaran, Claus Rinne, Benoit Coutu, R Aaron Low, Vidal Essebag, Carlos Morillo, Damian Redfearn, Satish Toal, Giuliano Becker, Michel Degrâce, Bernard Thibault, Eugene Crystal, Stanley Tung, John LeMaitre, Omar Sultan, Matthew Bennett, Jamil Bashir, Felix Ayala-Paredes, Philippe Gervais, Leon Rioux, Martin E W Hemels, Leon H R Bouwels, Bob van Vlies, Jia Wang, Derek V Exner, Paul Dorian, Ratika Parkash, Marco Alings, Stuart J Connolly
BACKGROUND: Infection of implanted medical devices has catastrophic consequences. For cardiac rhythm devices, pre-procedural cefazolin is standard prophylaxis but does not protect against methicillin-resistant gram-positive organisms, which are common pathogens in device infections. OBJECTIVE: This study tested the clinical effectiveness of incremental perioperative antibiotics to reduce device infection. METHODS: The authors performed a cluster randomized crossover trial with 4 randomly assigned 6-month periods, during which centers used either conventional or incremental periprocedural antibiotics for all cardiac implantable electronic device procedures as standard procedure...
December 18, 2018: Journal of the American College of Cardiology
Mitsuru Yagi, Naobumi Hosogane, Nobuyuki Fujita, Eijiro Okada, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Takashi Asazuma, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, Kota Watanabe
BACKGROUND CONTEXT: Corrective surgery for adult spinal deformity (ASD) improves health-related quality of life but has high complication rates. Predicting a patient's risk of perioperative and late postoperative complications is difficult, although several potential risk factors have been reported. PURPOSE: To establish an accurate, ASD-specific model for predicting the risk of postoperative complications, based on baseline demographic, radiographic, and surgical invasiveness data in a retrospective case series...
December 8, 2018: Spine Journal: Official Journal of the North American Spine Society
Mallory McKeon, Elliana Kirsh, Kosuke Kawai, David Roberson, Karen Watters
OBJECTIVES/HYPOTHESIS: Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary-care hospital...
December 8, 2018: Laryngoscope
Claire M Lawley, David S Winlaw, Gary F Sholler, Andrew Martin, Nadia Badawi, Karen Walker, Natasha Nassar, Samantha J Lain
The purpose of the study was to evaluate school-age developmental and educational outcomes for children with and without a cardiac procedure in the first year of life to improve understanding of longer-term neurodevelopmental outcomes in children who have had a cardiac procedure for congenital heart disease, the most common serious congenital anomaly. A population-based cohort study using record linkage of state-wide data was undertaken, evaluating children born in New South Wales, Australia, 2001-2007. Those with and without a cardiac procedure in the first year of life with a linked developmental (Australian version Early Development Instrument testing result, age 4-6 years) and/or educational outcome (Australian National Assessment Program result, age 7-9 years) were included...
December 10, 2018: Pediatric Cardiology
Maria S Altieri, Jie Yang, Donglei Yin, Konstantinos Spaniolas, Mark Talamini, Aurora Pryor
INTRODUCTION: Early readmissions (30 days) have been used as a measure of health care quality. The purpose of our study was to evaluate patterns of readmission for a longer period (up to 2 years) following Hepatopancreatobiliary (HPB) surgery in the state of New York. METHODS: The State Planning and Research Cooperative System database was utilized to identify patients undergoing complex HPB procedures between 2010 and 2012. Patients were followed for 2 years following surgery to identify all-cause readmissions...
December 10, 2018: Surgical Endoscopy
Rosaline S Zhang, Lawrence O Lin, Ian C Hoppe, Jordan W Swanson, Scott P Bartlett, Jesse A Taylor
BACKGROUND/PURPOSE: Patients with syndromic craniosynostosis and midface hypoplasia often undergo midface advancement to improve respiratory function, orbital relationships, and facial appearance. This study characterizes the perioperative morbidity of a large cohort of subjects who underwent transcranial or subcranial midface distraction. METHODS: Demographic and perioperative data were compared between those who underwent transcranial or subcranial midface DO between July 1999 and December 2017...
November 26, 2018: Plastic and Reconstructive Surgery
Peter Surace, Assem A Sultan, Jaiben George, Linsen T Samuel, Anton Khlopas, Robert M Molloy, Kim L Stearns, Michael A Mont
BACKGROUND: It has been established by previous studies that longer operative times can lead to higher rates of complications and poorer outcomes after total hip arthroplasty (THA). However, these studies were heterogeneous, examined limited complications, and have not provided a clear time after which complications increase. The aims of this study were to (1) assess whether longer operative time increases risk of complications within 30 days of THA, (2) investigate the relationship between operative time and various complications after THA, and (3) identify possible operative times beyond which complication rates increase...
November 20, 2018: Journal of Arthroplasty
M E Chua, J K Kim, K C Rivera, J M Ming, F Flores, W A Farhat
INTRODUCTION: The current literature on the use of antibiotics perioperatively for many pediatric procedures, including hypospadias, is inconsistent. There is currently no clear evidence for the use of postoperative antibiotic prophylaxis for stented distal hypospadias repair. OBJECTIVE: This study aims to synthesize and assess the available literature on the use versus non-use of postoperative antibiotic prophylaxis for stented distal hypospadias repair. METHODOLOGY: Systematic literature search was performed on March 2018 for evaluation of trials that assessed the use and non-use of postoperative prophylactic antibiotics among stented distal hypospadias repair in children...
November 1, 2018: Journal of Pediatric Urology
Mohammad H Eslami, Zein Saadeddin, Denis V Rybin, Gheorghe Doros, Jeffrey J Siracuse, Alik Farber
OBJECTIVE: The frailty index has been linked to adverse outcomes after surgical procedures. In this study, we evaluated the association between frailty index and outcomes after elective lower extremity bypass (LEB) for lower extremity ischemia. METHODS: The American College of Surgeons National Surgical Quality Improvement Program data set (2005-2012) was used to identify patients who underwent elective LEB using diagnostic and procedure Current Procedural Terminology codes...
October 24, 2018: Journal of Vascular Surgery
Mariano E Menendez, Sarah M Lawler, Jonathan Shaker, Nicole W Bassoff, Jon J P Warner, Andrew Jawa
BACKGROUND: As payment models shift toward a focus on value, an accurate understanding of surgical costs and preoperative correlates of high-cost patients is important for effective implementation of cost-saving strategies. This study used time-driven activity-based costing (TDABC) to explore inpatient cost of total shoulder arthroplasty (TSA) and to identify preoperative characteristics of high-cost patients. METHODS: Using TDABC, we calculated the cost of inpatient care for 415 patients undergoing elective primary TSA between 2016 and 2017...
December 5, 2018: Journal of Bone and Joint Surgery. American Volume
Eliza W Beal, Fabio Bagante, Anghela Paredes, Ozgur Akgul, Katiuscha Merath, Santino Cua, Mary E Dillhoff, Carl R Schmidt, Erik Abel, Scott Scrape, Aslam Ejaz, Timothy M Pawlik
BACKGROUND: Administration of blood products may be associated with increased morbidity and perioperative mortality in surgical patients. METHODS: Patients aged 18 + who underwent gastrointestinal surgery at the Ohio State University Wexner Medical Center 9/10/2015-5/9/2018 were identified. Multivariable logistic regression models were used to evaluate impact of blood product use on survival and complications, as well as to identify factors associated with receipt of transfusions...
November 27, 2018: American Journal of Surgery
Robert A Whittington, László Virág, Maud Gratuze, Hilana Lewkowitz-Shpuntoff, Mehdi Cheheltanan, Franck Petry, Isabelle Poitras, Françoise Morin, Emmanuel Planel
Preclinical studies have shown that anesthesia might accelerate the clinical progression of Alzheimer's disease (AD) and can have an impact on tau pathology, a hallmark of AD. Although benzodiazepines have been suggested to increase the risk of incident dementia, their impact on tau pathology in vivo is unknown. We thus examined the impact of midazolam, a benzodiazepine that is often administered perioperatively as an anxiolytic, on tau hyperphosphorylation in nontransgenic and in hTau mice, the latter a model of AD-like tau pathology...
November 8, 2018: Neurobiology of Aging
Lucio Cagini, Gabriela Cardaioli, Marco Andolfi, Ketty Savino, Paolo Eusebi, Ilenia Corbelli, Simone Simoni, Jacopo Vannucci, Elisa Sacchini, Francesco Ripandelli, Alberto Matricardi, Francesco Puma
BACKGROUND: Patent foramen ovale (PFO) is present in up to 25% of the general population and is considered an irrelevant condition in healthy subjects. Here we sought to determine an association between the presence of an asymptomatic PFO at baseline and postoperative short-term adverse events in patients undergoing major pulmonary resection for lung cancer. As well, we evaluated for the rate of PFO after pulmonary resections. METHODS: This prospective, observational study assessed patients by transcranial doppler (TCD) with contrast at baseline and discharge...
November 30, 2018: Annals of Thoracic Surgery
Laura Baker, Sean Bennett, Janelle Rekman, Aklile Workneh, Christopher Wherrett, Jad Abou-Khalil, Kimberly A Bertens, Fady K Balaa, Guillaume Martel
BACKGROUND: Perioperative red blood cell (RBC) transfusion is associated with poor outcomes in liver surgery. Hypovolemic phlebotomy (HP) is a novel intervention hypothesized to decrease transfusion requirements. The objective of this study was to examine this hypothesis. METHODS: Consecutive patients who underwent liver resection at one institution (2010-2016) were included. Factors found to be predictive of transfusion on univariate analysis and those previously published were modeled using multivariate logistic regression...
November 27, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Jessica P Simons, Andres Schanzer, Julie M Flahive, Nicholas H Osborne, Joseph L Mills, Andrew W Bradbury, Michael S Conte
OBJECTIVE: Accurate survival prediction critically influences decision-making in caring for patients with chronic limb-threatening ischemia (CLTI). The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial demonstrated that in patients who survived >2 years, there was a significant advantage to infrainguinal bypass compared with endovascular intervention, which increased with time. Validated survival models for patients with CLTI are lacking. METHODS: The Vascular Quality Initiative was interrogated for patients who underwent infrainguinal bypass or endovascular intervention for CLTI (January 2003-February 2017)...
November 26, 2018: Journal of Vascular Surgery
(no author information available yet)
OBJECTIVETemporary CSF diversion through an external ventricular drain (EVD) comes with the risk of EVD-related infections (ERIs). The incidence of ERIs varies from 0.8% to 22%. ERIs increase mortality, morbidity, length of stay, and costs; require prolonged courses of antibiotics; and increase the need for subsequent permanent CSF diversion. The authors report the results of a quality improvement project designed to improve infection rates and EVD placement using simulation training in addition to a standardized perioperative care bundle...
October 1, 2018: Journal of Neurosurgery
Christopher J Dy, Daniel A Osei, Travis G Maak, Michael B Gottschalk, Alan L Zhang, Michael D Maloney, Angela P Presson, Regis J O'Keefe
BACKGROUND: Although overlapping surgery is used to maximize efficiency, more empirical data are needed to guide patient safety. We conducted a retrospective cohort study to evaluate the safety of overlapping inpatient orthopaedic surgery, as judged by the occurrence of perioperative complications. METHODS: All inpatient orthopaedic surgical procedures performed at 5 academic institutions from January 1, 2015, to December 31, 2015, were included. Overlapping surgery was defined as 2 skin incisions open simultaneously for 1 surgeon...
November 21, 2018: Journal of Bone and Joint Surgery. American Volume
Masashi Takeuchi, Hirofumi Kawakubo, Shuhei Mayanagi, Yoshiyuki Suzuki, Koji Okabayashi, Toshiki Yamashita, Satoshi Kamiya, Tomoyuki Irino, Kazumasa Fukuda, Rieko Nakamura, Koichi Suda, Norihito Wada, Hiroya Takeuchi, Yuko Kitagawa
BACKGROUND: Although some predictive factors of long-term survival after a distal gastrectomy for gastric cancer have been reported, only few studies have predicted long-term outcomes based on preoperative parameters. We aimed to evaluate the reliability of perioperative risk calculator for predicting overall survival (OS) after distal gastrectomy in patients with gastric cancer. METHODS: Overall, 337 patients (225 males, 112 females) who had undergone a distal gastrectomy for gastric cancer at the Keio University Hospital, Tokyo, Japan, between January 2009 and December 2013 were enrolled in this study...
November 26, 2018: Gastric Cancer
John P Sheppard, Vera Ong, Carlito Lagman, Methma Udawatta, Courtney Duong, Thien Nguyen, Giyarpuram N Prashant, David S Plurad, Dennis Y Kim, Isaac Yang
BACKGROUND: External ventricular drain (EVD) placement is essential for the management of many neurocritical care patients. However, ventriculostomy-related infection (VRI) is a serious complication, and there remains no well-established protocol guiding use of perioperative or extended antibiotic prophylaxis to minimize risk of VRI. OBJECTIVE: To analyze published evidence on the efficacy of extended prophylactic antimicrobial therapy and antibiotic-coated external ventricular drains (ac-EVDs) in reducing VRI incidence...
November 26, 2018: Neurosurgery
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