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Quality improvment in cardiac surgery

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https://www.readbyqxmd.com/read/29664030/do-practice-gaps-exist-in-evidence-based-medication-prescription-at-hospital-discharge-in-patients-undergoing-coronary-artery-bypass-surgery-coronary-angioplasty
#1
Pradeep Pereira, Aditya Kapoor, Archana Sinha, Surendra K Agarwal, Shantanu Pande, Roopali Khanna, Nilesh Srivastava, Sudeep Kumar, Naveen Garg, Satyendra Tewari, Pravin Goel
Background & objectives: Prescription patterns of guideline-directed medical therapy (GDMT) after coronary artery bypass surgery [coronary artery bypass graft (CABG)] and percutaneous coronary intervention (PCI) at hospital discharge are often not optimal. In view of scarce data from the developing world, a retrospective analysis of medication advice to patients following CABG and PCI was conducted. Methods: Records of 5948 patients (post-PCI: 5152, post-CABG: 796) who underwent revascularization from 2010 to 2014 at a single tertiary care centre in north India were analyzed...
December 2017: Indian Journal of Medical Research
https://www.readbyqxmd.com/read/29663253/older-age-confers-a-higher-risk-of-30-day-morbidity-and-mortality-following-laparoscopic-bariatric-surgery-an-analysis-of-the-metabolic-and-bariatric-surgery-quality-improvement-program
#2
Ivy N Haskins, Tammy Ju, Ashlyn E Whitlock, Lisbi Rivas, Richard L Amdur, Paul P Lin, Khashayar Vaziri
INTRODUCTION: There is a paucity of literature describing the association of age with the risk of adverse events following bariatric surgery. The purpose of this study is to investigate the association of age with 30-day morbidity and mortality following laparoscopic bariatric surgery using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS: All adult patients undergoing laparoscopic Roux-en-Y gastric bypass (RNGYB) or sleeve gastrectomy (SG) were identified within the MBSAQIP database...
April 17, 2018: Obesity Surgery
https://www.readbyqxmd.com/read/29626685/discrepancy-between-neurosurgery-morbidity-and-mortality-conference-discussions-and-hospital-quality-metric-standards
#3
Lauren E Rotman, Matthew C Davis, Arsalaan A Salehani, Devin R Broadwater, Nathaniel H Reeve, Kristen O Riley
OBJECTIVE: Medical institutions use quality metrics to track complications seen in hospital admissions. Similarly, morbidity and mortality (M&M) conferences are held to peer review complications. The purpose of this study was to compare the complications identified in a cohort of patients within 30 days of neurosurgical intervention with those captured in a cohort of M&M conferences. METHODS: All complications that occurred within 30 days of surgery were obtained for patients admitted to the neurosurgical service between May and September 2013...
April 4, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29623673/the-relationship-between-age-and-chronic-kidney-disease-in-patients-undergoing-pancreatic-resection
#4
Derrick Antoniak, Chandrakanth Are, Chad Vokoun, Kaeli Samson, Lynette Smith, Jason Shiffermiller
BACKGROUND: Severe chronic kidney disease (CKD) predicts adverse outcomes in patients undergoing pancreatectomy, but the impact of milder CKD is unknown. Additionally, some authors have suggested that, due to physiologic changes of aging, CKD is over-diagnosed in patients above age 65. METHODS: Patients undergoing pancreatectomy for malignancy from 2005 to 2014 were identified from the National Surgical Quality Improvement Program. Primary outcomes were all-cause mortality and major complication, defined as myocardial infarction, cardiac arrest, stroke, venous thromboembolism, respiratory failure, deep surgical site infection, pneumonia, acute kidney injury, coma > 24 h, or re-operation occurring within 30 days of surgery...
April 5, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29621040/concomitant-repair-of-pelvic-floor-disorders-in-women-undergoing-surgery-for-gynecologic-malignancies
#5
Katarzyna Bochenska, Margaret Mueller, Julia Geynisman-Tan, Alix Leader-Cramer, Bhumy Davé, Christina Lewicky-Gaupp, Kimberly Kenton
OBJECTIVE: The aims of this study were to determine the rate and describe 30-day postoperative complications of concomitant pelvic organ prolapse and/or urinary incontinence (POPUI) procedures in women undergoing surgery for a gynecologic malignancy. METHODS: Women who underwent surgical intervention for a gynecologic malignancy between 2010 and 2014 were identified using postoperative International Classification of Diseases, Ninth Revision codes 179.0 to 184.9 in the American College of Surgeons National Surgical Quality Improvement Program database...
April 4, 2018: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/29607165/a-quality-improvement-program-with-nutrition-therapy-restriction-of-lipid-emulsions-in-cardiac-surgical-patients
#6
Jian Gao, Guo-Wei Tu, Chun-Sheng Wang, Du-Ming Zhu, Lan Liu, Hua Liu, Xiao-Mei Yang, Zhe Luo
Background: To evaluate the effect of restriction of soybean-based intravenous fat emulsions (IVFEs) in clinical outcomes in cardiac surgical patients. Methods: This was a before-and-after interventional study comparing the clinical outcomes regarding the intervention of IVFEs restriction. Before August 2015, parenteral nutrition (PN) using a soy-based lipid emulsion was routinely implemented if patients failed to meet >60% of energy requirements in 48 h post cardiac surgery (Period A)...
February 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29605041/surgeons-overestimate-postoperative-complications-and-death-when-compared-with-the-national-surgical-quality-improvement-project-risk-calculator
#7
Kevin Y Pei, James Healy, Kimberly A Davis
BACKGROUND: The assessment of postoperative morbidity and mortality is difficult particularly for complex patients. We hypothesize that surgeons overestimate the risk for complications and death after surgery in complex surgical patients. MATERIALS AND METHODS: General surgery residents and attending surgeons estimated the likelihood of any morbidity, mortality, surgical site infection, pneumonia, and cardiac complications for seven complex scenarios. Responses were compared with the American College of Surgeons National Surgical Quality Improvement Project Surgical Risk Calculator...
May 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29602750/standard-restrictive-sternal-precautions-and-modified-sternal-precautions-had-similar-effects-in-people-after-cardiac-surgery-via-median-sternotomy-smart-trial-a-randomised-trial
#8
Md Ali Katijjahbe, Catherine L Granger, Linda Denehy, Alistair Royse, Colin Royse, Rebecca Bates, Sarah Logie, Md Ali Nur Ayub, Sandy Clarke, Doa El-Ansary
QUESTION: In people who have undergone cardiac surgery via median sternotomy, does modifying usual sternal precautions to make them less restrictive improve physical function, pain, kinesiophobia and health-related quality of life? DESIGN: Two-centre, randomised, controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Seventy-two adults who had undergone cardiac surgery via a median sternotomy were included...
March 27, 2018: Journal of Physiotherapy
https://www.readbyqxmd.com/read/29599072/preoperative-immobility-significantly-impacts-the-risk-of-postoperative-complications-in-bariatric-surgery-patients
#9
Rana M Higgins, Melissa Helm, Jon C Gould, Tammy L Kindel
BACKGROUND: Preoperative immobility in general surgery patients has been associated with an increased risk of postoperative complications. It is unknown if immobility affects bariatric surgery outcomes. OBJECTIVES: The aim of this study was to determine the impact of immobility on 30-day postoperative bariatric surgery outcomes. SETTING: This study took place at a university hospital in the United States. METHODS: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 data set was queried for primary minimally invasive bariatric procedures...
March 5, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/29594089/the-need-for-specialized-pediatric-cardiac-critical-care-training-program-in-limited-resource-settings
#10
REVIEW
Indah K Murni, Ndidiamaka L Musa
Congenital heart disease (CHD) is one of the major global health problems with the highest birth prevalence in low- and middle-income countries. In these populous countries, basic health services for the children with CHD, including surgery, are lacking. Even though surgery is performed, outcome after cardiac surgery is influenced by the quality of the postoperative management with a reported high morbidity and mortality. Henceforth, there is an urgent need for comprehensive interventions to provide high quality cardiac intensive care programs to improve the quality of pediatric cardiac surgery services in order to address high morbidity and mortality after cardiac surgery...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29582429/early-intervention-mobilization-or-active-exercise-for-critically-ill-adults-in-the-intensive-care-unit
#11
REVIEW
Katherine A Doiron, Tammy C Hoffmann, Elaine M Beller
BACKGROUND: Survivors of critical illness often experience a multitude of problems that begin in the intensive care unit (ICU) or present and continue after discharge. These can include muscle weakness, cognitive impairments, psychological difficulties, reduced physical function such as in activities of daily living (ADLs), and decreased quality of life. Early interventions such as mobilizations or active exercise, or both, may diminish the impact of the sequelae of critical illness. OBJECTIVES: To assess the effects of early intervention (mobilization or active exercise), commenced in the ICU, provided to critically ill adults either during or after the mechanical ventilation period, compared with delayed exercise or usual care, on improving physical function or performance, muscle strength and health-related quality of life...
March 27, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29580777/quality-of-life-after-cardiac-surgery-based-on-the-minimal-clinically-important-difference-concept
#12
Nathalie Grand, Jean Baptiste Bouchet, Paul Zufferey, Anne Marie Beraud, Sahar Awad, Fabricio Sandri, Salvator Campisi, Jean François Fuzellier, Serge Molliex, Marco Vola, Jerome Morel
BACKGROUND: Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac surgery and to identify specific predictors of poor HRQOL. METHODS: In this prospective, single-center study, HRQOL was evaluated before and 6 months after surgery using the SF-36 questionnaire and its two components: the physical component summary (PCS) and the mental component summary (MCS)...
March 23, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29576107/steroids-in-cardiac-surgery-a-systematic-review-and-meta-analysis
#13
REVIEW
N Dvirnik, E P Belley-Cote, H Hanif, P J Devereaux, A Lamy, J M Dieleman, J Vincent, R P Whitlock
BACKGROUND: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction that may contribute to postoperative complications. Preventing this reaction with steroids may improve outcomes. We performed a systematic review to evaluate the impact of prophylactic steroids on clinical outcomes in patients undergoing on-pump cardiac surgery. METHODS: We searched MEDLINE, EMBASE, and Cochrane CENTRAL for randomised controlled trials (RCTs) comparing perioperative corticosteroid administration with a control group in adults undergoing CPB...
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29572215/health-related-quality-of-life-in-congenital-heart-disease-surgery-in-children-and-young-adults-a-systematic-review-and-meta-analysis
#14
Laila Akbar Ladak, Babar Sultan Hasan, Janice Gullick, Robyn Gallagher
BACKGROUND: As survival improves in the congenital heart disease (CHD) population, health-related quality of life (HRQOL) outcomes become increasingly important. While surgery improves survival, poor HRQOL occurs postoperatively and cardiac-related HRQOL outcomes are rarely reported. OBJECTIVE: To conduct a systematic review and meta-analyses of general and cardiac-related HRQOL in CHD surgical children and young adults. METHOD: Medline, CINAHL and EMBASE were searched...
March 23, 2018: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/29566140/conventional-aortic-valve-replacement-in-2005-elderly-patients-a-32-year-experience
#15
Thierry Langanay, Simon Rouzé, Jacques Tomasi, Marie Aymami, Syed M Rehman, Amedeo Anselmi, Hervé Corbineau, Erwan Flécher, Yves Logeais, Alain Leguerrier, Jean-Philippe Verhoye
OBJECTIVES: Considering the good immediate results reported for transcatheter aortic valve implantation in high-risk patients, the role of conventional aortic valve replacement (AVR) is being questioned, especially in elderly patients. The aim of this study was to evaluate our long-term results of conventional AVR in octogenarians. METHODS: A total of 2005 patients aged ≥80 years underwent AVR for aortic stenosis in our institution between 1978 and 2011. Of these, 1009 (50%) patients had an associated extracardiac comorbidity and 650 (32%) patients had coronary lesions...
March 16, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29562073/association-of-frailty-with-failure-to-rescue-after-low-risk-and-high-risk-inpatient-surgery
#16
Rupen Shah, Kristopher Attwood, Shipra Arya, Daniel E Hall, Jason M Johanning, Emmanuel Gabriel, Anthony Visioni, Steven Nurkin, Moshim Kukar, Steven Hochwald, Nader N Massarweh
Importance: Failure to rescue (FTR), or death after a potentially preventable complication, is a nationally endorsed, publicly reported quality measure. However, little is known about the impact of frailty on FTR, in particular after low-risk surgical procedures. Objective: To assess the association of frailty with FTR in patients undergoing inpatient surgery. Design, Setting, and Participants: This study assessed a cohort of 984 550 patients undergoing inpatient general, vascular, thoracic, cardiac, and orthopedic surgery in the National Surgical Quality Improvement Program between January 1, 2005, and December 31, 2012...
March 21, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29559083/the-effect-of-smoking-on-30-day-outcomes-in-elective-hernia-repair
#17
John O DeLancey, Eddie Blay, D Brock Hewitt, Kathryn Engelhardt, Karl Y Bilimoria, Jane L Holl, David D Odell, Anthony D Yang, Jonah J Stulberg
BACKGROUND: Adverse postoperative outcomes related to smoking are well established, yet current smokers continue to be offered elective surgery in the US. It is unknown whether patients undergoing low-risk, elective procedures, who actively smoke experience increased risk of complications. We sought to determine the increased burden of complications following elective hernia repair procedures in patients identified as current smokers. METHODS: We identified patients undergoing elective incisional, inguinal, umbilical, or ventral hernia repair from 2011 to 2014 using the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database...
March 6, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29559052/effect-of-gender-on-postoperative-morbidity-and-mortality-outcomes-a-retrospective-cohort-study
#18
Muhyeddine Al-Taki, Hamdi G Sukkarieh, Jamal J Hoballah, Sarah F Jamali, Mohamad Habbal, Karim Z Masrouha, Racha Abi-Melhem, Hani Tamim
Full extent of gender differences on postoperative outcomes has never been studied on large scale, specifically postoperative complications. This study aims to assess the effect of gender on 30-day morbidity and mortality after major surgery. A retrospective cohort study was carried out using data of patients undergoing major surgeries from the American College of Surgeons' National Surgical Quality Improvement Program database between 2008 and 2011. Demographics, pre- and perioperative risk factors, as well as 30-day morbidities, both overall and specific, were reviewed...
March 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29549136/sequential-cataract-surgeries-in-a-patient-with-a-left-ventricular-assist-device-lvad
#19
Alina Yang, Ji Liu
The population of patients on left ventricular assist devices (LVADs) has increased significantly since the 1990s, and with it, need for non-cardiac elective surgeries. Presence of an LVAD or heart failure, however, can cause physicians to perceive these patients to be at prohibitively high risk for elective surgery. Nevertheless, as one of the most common causes of poor vision in the elderly, cataracts can significantly limit improvements in quality of life that a patient may have otherwise gained from LVAD support...
March 16, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29546481/thirty-day-postoperative-morbidity-and-mortality-in-elderly-women-with-breast-cancer-an-analysis-of-the-nsqip-database
#20
Fernando A Angarita, Sergio A Acuna, Erin Cordeiro, Ahmad Elnahas, Subir Sutradhar, Timothy Jackson, Tulin D Cil
PURPOSE: Postoperative complication rates for elderly women undergoing breast cancer surgery have not been well studied. We describe the postoperative complication rates of elderly (≥ 70 years) women with breast cancer and compare them with young (40-69 years) women. METHODS: Data were extracted from the National Surgical Quality Improvement Program database (2004-2014). We included women with invasive breast cancer who underwent surgery. Outcomes were 30-day postoperative morbidity and mortality (complications), which were compared between young and elderly women...
March 15, 2018: Breast Cancer Research and Treatment
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