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Quality improvment in cardiac surgery

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https://www.readbyqxmd.com/read/28734627/the-impact-of-frailty-on-functional-survival-in-patients-1%C3%A2-year-after-cardiac-surgery
#1
James Lytwyn, Andrew N Stammers, D Scott Kehler, Patrick Jung, Bryce Alexander, Brett M Hiebert, Chris Dubiel, Dustin Kimber, Naomi Hamm, Mekayla Clarke, Carly Fraser, Brittany Pedreira, Todd A Duhamel, Navdeep Tangri, Rakesh C Arora
OBJECTIVE: This study determined whether frailty provides incremental value to the European System for Cardiac Operative Risk Evaluation II in identifying patients at risk of poor 1-year functional survival. METHODS: This prospective study in patients undergoing cardiac surgery defined frailty using 3 common definitions: (1) the Modified Fried Criteria; (2) the Short Physical Performance Battery; and (3) the Clinical Frailty Scale. The primary outcome was functional survival, defined as being alive at 1 year postsurgery with a health-related quality of life score greater than 60 on the EuroQol-Visual Analogue Scale...
June 24, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28722339/structured-pain-management-reduces-patient-discomfort-after-catheter-ablation-and-rhythm-device-surgery
#2
M Dörschner, A Bollmann, B Dinov, S Richter, M Döring, A Arya, A Müssigbrodt, S Kircher, N Dagres, P Sommer, G Hindricks, K Bode
BACKGROUND: The goal was to test the effectiveness of a structured pain management programme after invasive electrophysiological interventions in cardiology including ablation of atrial fibrillation (AF) or ventricular tachycardia (VT) and implantation, or explantation, of pacemakers or implantable cardioverter defibrillators. METHODS: This was a prospective study with a pre-/post-design where a post-intervention group (116 consecutive patients) was compared to a pre-intervention group (102 consecutive patients) after implementation of a structured pain-management programme using the numeric rating scale (NRS 0-10) and classified as moderate-to-severe if NRS > 3...
July 18, 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/28711400/thirty-day-outcomes-after-fenestrated-endovascular-repair-are-superior-to-open-repair-of-abdominal-aortic-aneurysms-involving-visceral-vessels
#3
Prateek K Gupta, Reshma Brahmbhatt, Kelly Kempe, Shaun M Stickley, Michael J Rohrer
OBJECTIVE: Although few studies have reported outcomes after branched or fenestrated endovascular aortic aneurysm repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-Vs), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcomes after FEVAR vs OS for AAA-Vs. METHODS: Patients who underwent FEVAR (n = 535) and OS (n = 1207) for elective AAA-Vs were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2008 to 2013 database...
July 13, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28706865/echocardiography-of-the-tricuspid-valve-acknowledgements
#4
Jamahal Luxford, Levi Bassin, Michael D'Ambra
The tricuspid valve (TV), although occasionally considered "neglected" is the subject of renewed and increasing interest. Factors include an awareness that tricuspid value dysfunction is influential in patient outcomes, an improving understanding of valve anatomy and function and evolving techniques available to address tricuspid regurgitation. Tricuspid regurgitation (TR) can be classified as being due to primary diseases of the valve or functional in nature, with the majority being functional. Whilst it was previously believed that such functional TR, resulting from left sided disease, would resolve after correction of the underlying pathology this is now known not to be true...
May 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28702944/impact-of-pre-operative-health-related-quality-of-life-on-outcomes-after-heart-surgery
#5
Ieva Norkienė, Indre Urbanaviciute, Greta Kezyte, Vaidas Vicka, Tomas Jovaisa
BACKGROUND: Long-term improvement in health-related quality of life (HRQOL) is one of the most important outcomes of cardiac surgery. The aim of this study is to define the impact of perioperative patient and procedural variables on HRQOL dynamics, a year after cardiac surgery. METHODS: Consecutive patients undergoing elective on-pump cardiac surgery were enrolled in this prospective observational cohort study. Patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire a day before surgery and once again a year after surgery...
July 12, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28698744/outcome-of-cardiac-rehabilitation-following-off-pump-versus-on-pump-coronary-bypass-surgery
#6
Reza Arefizadeh, Seyed Yaser Hariri, Adel Johari Moghadam
BACKGROUND: A few studies have compared the cardiac rehabilitation (CR) outcome between those who undergo conventional on-pump bypass surgery and off-pump surgery. We compared this outcome among the patients differentiated by the On-pump and off-pump surgical procedures about cardiovascular variables and psychological status. METHODS: This longitudinal study recruited 318 and 102 consecutive patients who had undergone CABG (on-pump surgery, n = 318 and off-pump surgery, n = 102) and been referred to the CR clinic...
June 15, 2017: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28696877/multicenter-quality-improvement-project-to-prevent-sternal-wound-infections-in-pediatric-cardiac-surgery-patients
#7
Cathy Woodward, Richard Taylor, Minnette Son, Roozbeh Taeed, Marshall L Jacobs, Lauren Kane, Jeffrey P Jacobs, S Adil Husain
BACKGROUND: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. METHODS: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries...
July 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28695972/the-incidence-of-postoperative-pneumonia-in-various-surgical-subspecialties-a-dual-database-analysis
#8
Morad Chughtai, Chukwuweike U Gwam, Anton Khlopas, Jared M Newman, Gannon L Curtis, Pedro A Torres, Rafay Khan, Michael A Mont
INTRODUCTION: Pneumonia is the third most common postoperative complication. However, its epidemiology varies widely and is often difficult to assess. For a better understanding, we utilized two national databases to determine the incidence of postoperative pneumonia after various surgical procedures. Specifically, we used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and the Nationwide Inpatient Sample (NIS) to determine the incidence and yearly trends of postoperative pneumonia following orthopaedic, urologic, otorhinolaryngologic, cardiothoracic, neurosurgery, and general surgeries...
July 11, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28648651/the-impact-of-functional-status-on-the-outcomes-of-endovascular-lower-extremity-revascularization-for-critical-limb-ischemia-in-the-elderly
#9
Isidore Dinga Madou, Martin D Slade, Kristine C Orion, Timur Sarac, Cassius Iyad Ochoa Chaar
INTRODUCTION: Functional status is an important predictor of outcomes after infrainguinal bypass surgery. There is little data on the effect of functional status on the outcomes of endovascular LE interventions, especially in the elderly frail population. METHODS: This is a retrospective analysis of the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) files for the years 2011-2013 to assess the impact of functional status on outcome after endovascular intervention for critical limb ischemia...
June 22, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28643011/prevalence-and-risk-factors-for-cardiac-arrest-and-myocardial-infarction-after-pelvic-reconstructive-surgery-a-national-multi-institutional-surgical-database-study
#10
David Sheyn, Sangeeta Mahajan, Sherif El-Nashar, Adonis Hijaz, Xiao-Yu Wang, Jeff Mangel
INTRODUCTION AND HYPOTHESIS: There is limited data available regarding the risk for perioperative cardiac morbidity following pelvic reconstructive surgery (PRS). We sought to determine the incidence of cardiac arrest and myocardial infarction within 30 days of pelvic organ prolapse (POP) surgery and determine which factors may contribute to an increased risk of these complications. METHODS: Using the American College of Surgeons National Quality Improvement Program (NSQIP) database, we identified patients who underwent PRS procedures between 2010 to 2015 using Current Procedural Terminology (CPT) codes...
June 22, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/28638156/goal-directed-perfusion-methodology-for-determining-oxygenator-performance-during-clinical-cardiopulmonary-bypass
#11
Alfred H Stammers, Randi Miller, Stephen G Francis, Laszlo Fuzesi, Anthony Nostro, Eric Tesdahl
New generation oxygenators incorporate arterial line filtration either sequential to, or directly in, the gas exchange module. This unique design may affect gas exchange performance by altering the operational characteristics of the device. The present study was designed to evaluate three oxygenators in a clinical setting using a goal-directed perfusion algorithm during cardiopulmonary bypass (CPB). After institutional review board approval, 60 adult patients undergoing cardiac surgery for acquired heart disease were matched for disease state and body size into three groups based on oxygenator type: Terumo SX18(™) (n = 20), Terumo FX15(™) (n = 20), and LivaNova Inspire6F(™) 6 Dual (n = 20)...
June 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28617685/adult-congenital-heart-disease-magnitude-of-the-problem
#12
Akanksha N Thakkar, Ponraj Chinnadurai, C Huie Lin
PURPOSE OF REVIEW: To define the magnitude of problems faced by patients with adult congenital heart disease (ACHD) and to identify unmet needs for this population. RECENT FINDINGS: The ACHD population is estimated to include more than 1 million people in the United States and continues to grow at a steady rate. Owing to the decline in early mortality in this group, modern medicine is now faced by the long-term complications associated with congenital heart disease such as chronic heart failure, increased endocarditis risk, elevated burden of arrhythmias, pulmonary hypertension, valvular dysfunction, and pregnancy...
June 15, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28580856/short-term-perioperative-complications-and-mortality-after-total-ankle-arthroplasty-in-the-united-states
#13
Kenneth A Heida, Brian Waterman, Eric Tatro, Julia Bader, Andrew C McCoy, Nicholas Rensing, Justin Orr
This study sought to identify patient and operative demographics associated with 30-day perioperative complications in patients undergoing total ankle arthroplasty as recorded in the National Surgical Quality Improvement Project database. Complications were divided into local and systemic and further subcategorized as major and minor. A total of 404 patients underwent total ankle arthroplasty between 2007 and 2014 as captured in the National Surgical Quality Improvement Project database. The overall complication rate was 2...
June 1, 2017: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/28577849/the-society-of-thoracic-surgeons-adult-cardiac-surgery-database-2017-update-on%C3%A2-research
#14
Vinod H Thourani, Vinay Badhwar, David M Shahian, Fred H Edwards, Sean O'Brien, Robert H Habib, John J Kelly, J Scott Rankin, Richard Prager, Jeffrey P Jacobs
Containing more than 6 million cumulative operative records and accounting for 90% to 95% of adult cardiac surgery performed in the United States, The Society of Thoracic Surgeons Adult Cardiac Surgery Database is an invaluable resource for performance assessment, quality improvement, and clinical research. This article reviews the seven major research efforts published in 2016 that utilized the Adult Cardiac Surgery Database. Two studies evaluated national trends in clinical practice, three assessed the effect of several risk factors on postoperative morbidity and mortality, and two developed new models to evaluate quality of care...
July 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28575211/clinical-outcomes-in-patients-after-extracorporeal-membrane-oxygenation-support-for-post-cardiotomy-cardiogenic-shock-a-single-centre-experience-of-92-cases%C3%A2
#15
Julien Guihaire, Simon Dang Van, Simon Rouze, Sébastien Rosier, Antoine Roisne, Thierry Langanay, Hervé Corbineau, Jean-Philippe Verhoye, Erwan Flécher
OBJECTIVES: Post-cardiotomy cardiogenic shock is a major concern in cardiac surgery. We reviewed our experience of extracorporeal membrane oxygenation (ECMO) as temporary circulatory support in post-cardiotomy cardiogenic shock. METHODS: Between January 2005 and December 2014, adult patients implanted with ECMO after cardiac surgical procedures were included. Indications for ECMO were failure to be withdrawn from cardiopulmonary bypass or refractory cardiogenic shock occurring during postoperative Days 1 and 2...
June 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28569337/the-assessment-of-the-complexity-of-care-through-the-clinical-nursing-information-system-in-clinical-practice-a-study-protocol
#16
C Bravetti, A Cocchieri, F D'Agostino, R Alvaro, M Zega
BACKGROUND: The costs of nursing staff amounts to approximately 50% of the total budget of the health workforce and accounts for 20% to 30% of the total costs incurred by the health care companies. The goal of the study, by analyzing the complexity of care, is to provide a quantification of the assistance delivered, through the assessment of the technical aspects of the welfare activities according to the variable of time. Data from these activities flow into the clinical nursing information system Professional Assessment Instrument - PAI - which is used at the health facility involved in this study...
July 2017: Annali di Igiene: Medicina Preventiva e di Comunità
https://www.readbyqxmd.com/read/28566404/pre-operative-functional-status-as-a-predictor-of-morbidity-and-mortality-after-elective-cervical-spine-surgery
#17
S V Minhas, A S Mazmudar, A A Patel
AIMS: Patients seeking cervical spine surgery are thought to be increasing in age, comorbidities and functional debilitation. The changing demographics of this population may significantly impact the outcomes of their care, specifically with regards to complications. In this study, our goals were to determine the rates of functionally dependent patients undergoing elective cervical spine procedures and to assess the effect of functional dependence on 30-day morbidity and mortality using a large, validated national cohort...
June 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28554921/selection-by-a-panel-of-clinicians-and-family-representatives-of-important-early-morbidities-associated-with-paediatric-cardiac-surgery-suitable-for-routine-monitoring-using-the-nominal-group-technique-and-a-robust-voting-process
#18
Christina Pagel, Katherine L Brown, Isobel McLeod, Helen Jepps, Jo Wray, Linda Chigaru, Andrew McLean, Tom Treasure, Victor Tsang, Martin Utley
OBJECTIVE: With survival following paediatric cardiac surgery improving, the attention of quality assurance and improvement initiatives is shifting to long-term outcomes and early surgical morbidities. We wanted to involve family representatives and a range of clinicians in selecting the morbidities to be measured in a major UK study. SETTING: Paediatric cardiac surgery services in the UK. PARTICIPANTS: We convened a panel comprising family representatives, paediatricians from referring centres, and surgeons and other clinicians from surgical centres...
May 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28552372/impact-of-medicaid-expansion-on-cardiac-surgery-volume-and-outcomes
#19
Eric J Charles, Lily E Johnston, Morley A Herbert, J Hunter Mehaffey, Kenan W Yount, Donald S Likosky, Patricia F Theurer, Clifford E Fonner, Jeffrey B Rich, Alan M Speir, Gorav Ailawadi, Richard L Prager, Irving L Kron
BACKGROUND: Thirty-one states approved Medicaid expansion after implementation of the Affordable Care Act. The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. METHODS: Data from the Virginia (nonexpansion state) Cardiac Services Quality Initiative and the Michigan (expanded Medicaid, April 2014) Society of Thoracic and Cardiovascular Surgeons Quality Collaborative were analyzed to identify uninsured and Medicaid patients undergoing coronary bypass graft or valve operations, or both...
May 26, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28549015/early-oral-feeding-following-mckeown-minimally-invasive-esophagectomy-an-open-label-randomized-controlled-noninferiority-trial
#20
Hai-Bo Sun, Yin Li, Xian-Ben Liu, Rui-Xiang Zhang, Zong-Fei Wang, Toni Lerut, Chia-Chuan Liu, Alfonso Fiorelli, Yin-Kai Chao, Daniela Molena, Robert J Cerfolio, Soji Ozawa, Andrew C Chang
OBJECTIVE: Our objective was to evaluate the impact of early oral feeding (EOF) on postoperative cardiac, respiratory, and gastrointestinal (CRG) complications after McKeown minimally invasive esophagectomy for esophageal cancer. SUMMARY BACKGROUND DATA: Nil-by-mouth with enteral tube feeding is routinely practiced after esophagectomy. METHODS: Patients were randomly allocated to receive oral feeding on the first postoperative day (EOF group) or late oral feeding (LOF group) 7 days after surgery...
May 25, 2017: Annals of Surgery
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