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Quality improvment in cardiac surgery

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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
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/28548204/endovascular-treatment-for-ruptured-abdominal-aortic-aneurysm
#12
REVIEW
Stephen Badger, Rachel Forster, Paul H Blair, Peter Ellis, Frank Kee, Denis W Harkin
BACKGROUND: An abdominal aortic aneurysm (AAA) (pathological enlargement of the aorta) is a condition that can occur as a person ages. It is most commonly seen in men older than 65 years of age. Progressive aneurysm enlargement can lead to rupture and massive internal bleeding, which is fatal unless timely repair can be achieved. Despite improvements in perioperative care, mortality remains high (approximately 50%) after conventional open surgical repair. Endovascular aneurysm repair (EVAR), a minimally invasive technique, has been shown to reduce early morbidity and mortality as compared to conventional open surgery for planned AAA repair...
May 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28544343/levels-of-anxiety-in-parents-in-the-24-h-before-and-after-their-child-s-surgery-a-descriptive-study
#13
Laura Pomicino, Elena Maccacari, Sara Buchini
AIMS AND OBJECTIVES: To: a. investigate pre and post-operative anxiety levels in parents of surgical patients; b. identify factors that affect parental anxiety; c. analyze assistance provided and overall parental satisfaction in order to assess if and how this aspect can impact their anxiety level. BACKGROUND: Surgery as an event generates anxiety in children and their parents. Children who are anxious before surgery are likely to develop more postoperative psychological and physiological complications than those who are not...
May 25, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28539544/postoperative-outcome-of-high-risk-octogenarians-undergoing-cardiac-surgery-a-multicenter-observational-retrospective-study
#14
Michal Porizka, Jan Kunstyr, Tomas Vanek, Michal Nejedly, Jana Buckova, Jiri Mokrejs, Frantisek Mosna
PURPOSE: Cardiac surgery in octogenarians with severely deteriorated functional status is increasingly common, but outcome data are still limited. The aim of this study was to compare postoperative outcome, survival, and quality of life of low-, medium-, and high-risk octogenarians undergoing cardiac surgery. METHODS: In all, 285 Czech octogenarians who underwent any cardiac surgical procedure between January 2011 and December 2012 were included in the study. Five out of all twelve national adult cardiac surgical centers participated in the study, representing almost half of all octogenarians operated in our country in that period...
May 24, 2017: Annals of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28499655/validating-the-thoracic-revised-cardiac-risk-index-following-lung-resection
#15
Daniel C Thomas, Justin D Blasberg, Brian N Arnold, Joshua E Rosen, Michelle C Salazar, Frank C Detterbeck, Daniel J Boffa, Anthony W Kim
BACKGROUND: The Thoracic Revised Cardiac Index (ThRCRI) is a tool that differentiates patients who may proceed to lung resection (classes A or B) from those who should receive additional cardiac evaluation (classes C or D). This study aims to describe the ability of the ThRCRI to stratify patients based on major cardiac complication rates using a large multi-institutional dataset. METHODS: Patients undergoing lobectomy or pneumonectomy were identified in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2005 to 2012...
May 9, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28484915/impact-of-marital-status-and-comorbid-disorders-on-health-related-quality-of-life-after-cardiac-surgery
#16
Ann Kristin Bjørnnes, Monica Parry, Ragnhild Falk, Judy Watt-Watson, Irene Lie, Marit Leegaard
PURPOSE: To explore associations between HRQL, marital status, and comorbid disorders in men and women following cardiac surgery. METHOD: A secondary analysis was completed using data from a randomized controlled trial in which 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery were recruited between March 2012 and September 2013. HRQL was assessed using the Health State Descriptive System (15D) preoperatively, then at 2 weeks, and at 3, 6, and 12 months following cardiac surgery...
May 8, 2017: Quality of Life Research
https://www.readbyqxmd.com/read/28475665/routine-use-of-viscoelastic-blood-tests-for-diagnosis-and-treatment-of-coagulopathic-bleeding-in-cardiac-surgery-updated-systematic-review-and-meta-analysis
#17
G F Serraino, G J Murphy
Viscoelastic point-of-care tests are commonly used to provide prompt diagnosis of coagulopathy and allow targeted treatments in bleeding patients. We updated existing meta-analyses that have evaluated the clinical effectiveness of viscoelastic point-of-care tests vs the current standard of care for the management of cardiac surgery patients at risk of coagulopathic bleeding. Randomized controlled trials comparing viscoelastic point-of-care diagnostic testing with standard care in cardiac surgery patients were sought...
June 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28475274/remote-ischaemic-preconditioning-for-coronary-artery-bypass-grafting-with-or-without-valve-surgery
#18
REVIEW
Carina Benstoem, Christian Stoppe, Oliver J Liakopoulos, Julia Ney, Dirk Hasenclever, Patrick Meybohm, Andreas Goetzenich
BACKGROUND: Despite substantial improvements in myocardial preservation strategies, coronary artery bypass grafting (CABG) is still associated with severe complications. It has been reported that remote ischaemic preconditioning (RIPC) reduces reperfusion injury in people undergoing cardiac surgery and improves clinical outcome. However, there is a lack of synthesised information and a need to review the current evidence from randomised controlled trials (RCTs). OBJECTIVES: To assess the benefits and harms of remote ischaemic preconditioning in people undergoing coronary artery bypass grafting, with or without valve surgery...
May 5, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28458959/preoperative-radiotherapy-is-not-associated-with-increased-post-mastectomy-short-term-morbidity-analysis-of-77-902-patients
#19
Pablo A Baltodano, Myrna Eliann Reinhardt, José M Flores, Francis M Abreu, Anmol Chattha, Lyonell Kone, Carisa M Cooney, Michele A Manahan, Richard C Zellars, Gedge D Rosson
BACKGROUND: Neoadjuvant radiotherapy (NRT) enhances breast-conserving surgery outcomes, reducing local recurrence of breast cancer and increasing median survival. However, its effect on postoperative morbidity remains under-studied. We sought to assess the impact of NRT on 30-day postoperative morbidity after mastectomy. METHODS: We analyzed data from women undergoing mastectomy (with or without immediate reconstruction) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2011 datasets...
March 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28451835/significance-of-sequential-cardiac-rehabilitation-program-through-inter-hospital-cooperation-between-acute-care-and-rehabilitation-hospitals-in-elderly-patients-after-cardiac-surgery-in-japan
#20
Tomoyuki Morisawa, Katsuhiro Ueno, Yuko Fukuda, Naoto Kanazawa, Hiroshi Kawaguchi, Rikito Zaiki, Hiroaki Fuzisaki, Haruka Yoshioka, Maki Sasaki, Kentaro Iwata, Tadaaki Koyama, Takeshi Kitai, Yutaka Furukawa, Tetsuya Takahashi
This study is to evaluate the impact of cooperation between acute care hospital and rehabilitation hospital on physical function, exercise tolerance, activities of daily living (ADL), health-related quality of life (HR-QOL), and psychological function in heart disease patients undergoing cardiac rehabilitation. Among patients undergoing concurrent medical treatment and cardiac rehabilitation starting early in acute care hospitalization, we selected 30 patients who required continued cardiac rehabilitation in rehabilitation hospitals as subjects...
April 27, 2017: Heart and Vessels
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