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Quality improvment in cardiac surgery

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https://www.readbyqxmd.com/read/27912774/socioeconomic-inequalities-in-health-related-quality-of-life-between-men-and-women-5%C3%A2-years-after-a-coronary-angiography
#1
Anastase Tchicaya, Nathalie Lorentz
BACKGROUND: The aim of this study is to measure gender differences in health-related quality of life (HRQOL) among men and women patients with cardiovascular diseases (CVD), and to assess the impact of socioeconomic factors on HRQOL between men and women, 5 years after a coronary angiography. METHODS: The study included 1,289 out of 4,391 patients who had undergone an angiography in the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg in 2008/2009...
December 3, 2016: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/27908815/regional-variation-in-postoperative-myocardial-infarction-in-patients-undergoing-vascular-surgery-in-the-united-states
#2
Andrea M Steely, Peter W Callas, Daniel Neal, Salvatore T Scali, Philip P Goodney, Andres Schanzer, Jack L Cronenwett, Daniel J Bertges
OBJECTIVE: To assess for regional variation in the incidence of postoperative myocardial infarction (POMI) following non-emergent vascular surgery across the United States in order to identify potential areas for quality improvement initiatives. METHODS: We evaluated POMI rates across 17 regional Vascular Quality Initiative (VQI) groups comprised of 243 centers with 1,343 surgeons who performed 75,057 vascular operations from 2010-2014. Four procedures were included in the analysis: carotid endarterectomy (CEA, n=39,118), endovascular abdominal aortic aneurysm (AAA) repair (EVAR, n=15,106), infra-inguinal bypass (INFRA, n=17,176), and open infra-renal AAA repair (OAAA, n=3,657)...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27892423/a-european-study-on-effectiveness-and-sustainability-of-current-cardiac-rehabilitation-programmes-in-the-elderly-design-of-the-eu-care-randomised-controlled-trial
#3
Eva Prescott, Esther P Meindersma, Astrid E van der Velde, Jose R Gonzalez-Juanatey, Marie Christine Iliou, Diego Ardissino, Giuseppe Biondi Zoccai, Uwe Zeymer, Leonie F Prins, Arnoud Wj Van't Hof, Matthias Wilhelm, Ed P de Kluiver
BACKGROUND: Cardiac rehabilitation (CR) is an evidence-based intervention to increase survival and quality of life. Yet studies consistently show that elderly patients are less frequently referred to CR, show less uptake and more often drop out of CR programmes. DESIGN: The European study on effectiveness and sustainability of current cardiac rehabilitation programmes in the elderly (EU-CaRE) project consists of an observational study and an open prospective, investigator-initiated multicentre randomised controlled trial (RCT) involving mobile telemonitoring guided CR (mCR)...
October 2016: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/27884412/the-society-of-thoracic-surgeons-adult-cardiac-surgery-database-2017-update-on-outcomes-and-quality
#4
Richard S D'Agostino, Jeffrey P Jacobs, Vinay Badhwar, Gaetano Paone, J Scott Rankin, Jane M Han, Donna McDonald, Fred H Edwards, David M Shahian
Established in 1989, The Society of Thoracic Surgeons Adult Cardiac Surgery Database is one of the most comprehensive clinical data registries in health care. It is widely regarded as the gold standard for benchmarking risk-adjusted outcomes in cardiac surgery and is the foundation for all quality measurement and improvement activities of The Society of Thoracic Surgeons. This is the second in a series of annual reports that summarizes current aggregate national outcomes in cardiac surgery and reviews database-related activities in the areas of quality measurement and performance improvement during the past year...
November 21, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27881360/an-observational-registry-of-carotid-endarterectomy-and-carotid-artery-stenting-in-brazil-study-protocol
#5
Edwaldo Edner Joviliano, Winston Bonetti Yoshida, Marcone Lima Sobreira, Regina Moura, Ana Terezinha Guillaumon, Selma Regina De Oliveira Raymundo, Daniel Gustavo Miquelin, Ludvig Hafner, Marcelo Jose Almeida
BACKGROUND: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. CEA has been considered the first-line treatment for carotid stenosis worldwide, and the safety and efficacy of CAS compared to CEA remains in question. OBJECTIVE: The purpose of this study is to compare the practice and outcomes of CAS and CEA in a real-world setting within public university hospitals in Brazil...
November 23, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27869890/-anmco-sic-sici-gise-sicch-consensus-document-risk-stratification-in-elderly-patients-undergoing-cardiac-surgery-and-transcatheter-aortic-valve-implantation
#6
Giovanni Pulignano, Michele Massimo Gulizia, Samuele Baldasseroni, Francesco Bedogni, Giovanni Cioffi, Ciro Indolfi, Francesco Romeo, Adriano Murrone, Francesco Musumeci, Alessandro Parolari, Leonardo Patanè, Paolo Giuseppe Pino, Annalisa Mongiardo, Carmen Spaccarotella, Roberto Di Bartolomeo, Giuseppe Musumeci
Aortic stenosis is one the most frequent valvular diseases in developed countries, and its impact on public healthcare resources and assistance is increasing. A substantial proportion of elderly patients with severe aortic stenosis is frequently not eligible for surgery because of advanced age, frailty and multiple comorbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy...
September 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27865060/reducing-variation-in-feeding-newborns-with-congenital-heart-disease
#7
Janet M Simsic, Kirby-Rose Carpenito, Kristin Kirchner, Stephanie Peters, Holly Miller-Tate, Brian Joy, Mark Galantowicz
OBJECTIVE: Enteral feeding is associated with decreased infection rates, decreased mechanical ventilation, decreased hospital length of stay, and improved wound healing. Enteral feeding difficulties are common in congenital heart disease. Our objective was to develop experience-based newborn feeding guidelines for the initiation and advancement of enteral feeding in the cardiothoracic intensive care unit. DESIGN: This is a retrospective analysis of a quality improvement project...
November 16, 2016: Congenital Heart Disease
https://www.readbyqxmd.com/read/27863593/quality-of-life-in-elder-adults-one-year-after-coronary-bypass
#8
Fredrike Blokzijl, Iwan C C van der Horst, Eric Keus, Tjalling W Waterbolk, Massimo A Mariani, Willem Dieperink
BACKGROUND: Survival rates in the elderly after cardiac surgery have improved over the last decades and therewith more attention is directed toward Quality of Life (QoL) as a patient reported outcome measure. OBJECTIVE: The purpose of this study was to explore QoL in patients one year after coronary artery bypass grafting, with special interest in the elderly patients (≥80 years). METHODS: In a quantitative, retrospective single-center study patients with isolated coronary artery bypass grafting (eg, nonvalve) surgery aged 80 years or older and operated in 2013 were included (n = 32)...
December 2016: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
https://www.readbyqxmd.com/read/27832832/a-pilot-goal-directed-perfusion-initiative-is-associated-with-less-acute-kidney-injury-after-cardiac-surgery
#9
J Trent Magruder, Todd C Crawford, Herbert Lynn Harness, Joshua C Grimm, Alejandro Suarez-Pierre, Chad Wierschke, Jim Biewer, Charles Hogue, Glenn R Whitman, Ashish S Shah, Viachaslau Barodka
BACKGROUND: We sought to determine whether a pilot goal-directed perfusion initiative could reduce the incidence of acute kidney injury after cardiac surgery. METHODS: On the basis of the available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery >300 mL O2/min/m(2) and reduction in vasopressor use) that were combined into a goal-directed perfusion initiative and implemented as a quality improvement measure in patients undergoing cardiac surgery at Johns Hopkins during 2015...
September 19, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27807090/surgical-ablation-of-atrial-fibrillation-a-protocol-for-a-systematic-review-and-meta-analysis-of-randomised-controlled-trials
#10
Graham R McClure, Emilie P Belley-Cote, Rohit K Singal, Iqbal H Jaffer, Nazari Dvirnik, Kevin R An, Gabriel Fortin, Jessica Spence, Richard P Whitlock
INTRODUCTION: Atrial fibrillation (AF) affects 10% of patients undergoing cardiac surgery and is an independent risk factor for all-cause mortality, ischaemic stroke and heart failure. Surgical AF ablation has been shown to significantly improve maintenance of sinus rhythm, however, small to medium size trials conducted to date lack the power required to assess patient-important outcomes such as mortality, stroke, heart failure and health-related quality of life. Moreover, a recent randomised trial (RCT) suggested harm by surgical AF ablation with an almost threefold increase in the requirement for permanent pacemaker postablation...
November 2, 2016: BMJ Open
https://www.readbyqxmd.com/read/27779967/dysphagia-after-cardiac-operations-is-associated-with-increased-length-of-stay-and-costs
#11
Son Nguyen, Allen Zhu, William Toppen, Adeel Ashfaq, Jessica Davis, Richard Shemin, Abie H Mendelsohn, Peyman Benharash
Although the true incidence of postoperative dysphagia after cardiac surgery is unknown, it has been reported to occur in 3 to 21.6 per cent of patients. Historically, dysphagia has been associated with increased surgical complications and prolonged hospital stay. This study aimed to evaluate the costs and outcomes associated with dysphagia after cardiac surgery. Patients undergoing nonemergent, nontransplant cardiac operations between June 2013 and June 2014 were eligible for inclusion. Independent predictors of cost were identified through a multivariate linear regression model...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27775998/impact-of-methylprednisolone-on-postoperative-quality-of-recovery-and-delirium-in-the-steroids-in-cardiac-surgery-trial-a-randomized-double-blind-placebo-controlled-substudy
#12
Colin F Royse, Leif Saager, Richard Whitlock, Jared Ou-Young, Alistair Royse, Jessica Vincent, P J Devereaux, Andrea Kurz, Ahmed Awais, Krit Panjasawatwong, Daniel I Sessler
BACKGROUND: Inflammation after cardiopulmonary bypass may contribute to postoperative delirium and cognitive dysfunction. The authors evaluated the effect of high-dose methylprednisolone to suppress inflammation on the incidence of delirium and postoperative quality of recovery after cardiac surgery. METHODS: Five hundred fifty-five adults from three hospitals enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial were randomly allocated to placebo or 250 mg methylprednisolone at induction and 250 mg methylprednisolone before cardiopulmonary bypass...
October 24, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27748695/efficacy-of-%C3%AE-blocker-therapy-for-secondary-prevention-for-patients-undergoing-coronary-artery-bypass-grafting-surgery
#13
Cheng Sun, Heng Zhang, Zhe Zheng
PURPOSE OF REVIEW: The efficacy and safety of β-blockers in the treatment of cardiovascular diseases, such as ischemic heart disease, cardiac arrhythmias, and heart failure, have been well established for decades. In this article, we review the current opinions on the application of β-blockers for secondary prevention in patients undergoing coronary artery bypass grafting (CABG) surgery. RECENT FINDINGS: As the average age of patients treated surgically for coronary artery disease (CAD) is increasing, it is not uncommon to have candidates for CABG presenting with concomitant atrial fibrillation, heart failure or hypertension, most of which were caused by excessive activation of the adrenergic nervous system...
November 2016: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/27745841/surgical-unroofing-of-hemodynamically-significant-left-anterior-descending-myocardial-bridges
#14
Jack H Boyd, Vedant S Pargaonkar, David H Scoville, Ian S Rogers, Takumi Kimura, Shigemitsu Tanaka, Ryotaro Yamada, Michael P Fischbein, Jennifer A Tremmel, Robert Scott Mitchell, Ingela Schnittger
BACKGROUND: Left anterior descending artery myocardial bridges (MBs) range from clinically insignificant incidental angiographic findings to a potential cause of sudden cardiac death. Within this spectrum, a group of patients with isolated, symptomatic, and hemodynamically significant MBs despite maximally tolerated medical therapy exist for whom the optimal treatment is controversial. We evaluated supraarterial myotomy, or surgical unroofing, of the left anterior descending MBs as an isolated procedure in these patients...
October 1, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27733826/use-of-a-structured-mirrors-intervention-does-not-reduce-delirium-incidence-but-may-improve-factual-memory-encoding-in-cardiac-surgical-icu-patients-aged-over-70-years-a-pilot-time-cluster-randomized-controlled-trial
#15
Kimberly Giraud, Megan Pontin, Linda D Sharples, Paul Fletcher, Tim Dalgleish, Allaina Eden, David P Jenkins, Alain Vuylsteke
Introduction: Post-operative delirium remains a significant problem, particularly in the older surgical patient. Previous evidence suggests that the provision of supplementary visual feedback about ones environment via the use of a mirror may positively impact on mental status and attention (core delirium diagnostic domains). We aimed to explore whether use of an evidence-based mirrors intervention could be effective in reducing delirium and improving post-operative outcomes such as factual memory encoding of the Intensive Care Unit (ICU) environment in older cardiac surgical patients...
2016: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/27733069/current-status-of-transcatheter-mitral-valve-repair-therapies-from-surgical-concepts-towards-future-directions
#16
Sten Lyager Nielsen
Transcatheter mitral valve (MV) intervention has emerged as an effective treatment option for symptomatic severe mitral regurgitation (MR) in patients considered to be inoperable or at high operative risk for surgical MV surgery. In primary mitral regurgitation, surgical repair is the standard of care. Transcatheter edge-to-edge MV repair with the MitraClip system has the largest clinical experience to date and offers a sustained clinical benefit in selected surgical high-risk patients. Surgery for secondary MR remains a challenge...
November 6, 2016: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/27732721/clinical-practice-guidelines-from-the-aabb-red-blood-cell-transfusion-thresholds-and-storage
#17
Jeffrey L Carson, Gordon Guyatt, Nancy M Heddle, Brenda J Grossman, Claudia S Cohn, Mark K Fung, Terry Gernsheimer, John B Holcomb, Lewis J Kaplan, Louis M Katz, Nikki Peterson, Glenn Ramsey, Sunil V Rao, John D Roback, Aryeh Shander, Aaron A R Tobian
Importance: More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain. Objective: To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion. Evidence Review: Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions...
November 15, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27696513/is-there-an-optimal-preoperative-management-strategy-for-phaeochromocytoma-paraganglioma
#18
B G Challis, R T Casey, H L Simpson, M Gurnell
Phaeochromocytomas and paragangliomas (PPGLs) are catecholamine secreting neuroendocrine tumours that predispose to haemodynamic instability. Currently, surgery is the only available curative treatment, but carries potential risks including hypertensive and hypotensive crises, cardiac arrhythmias, myocardial infarction and stroke, due to tumoral release of catecholamines during anaesthetic induction and tumour manipulation. The mortality associated with surgical resection of PPGL has significantly improved from 20-45% in the early 20(th) century(1) to 0-2...
October 3, 2016: Clinical Endocrinology
https://www.readbyqxmd.com/read/27662564/hematocrit-levels-blood-testing-and-blood-transfusion-in-infants-after-heart-surgery
#19
Claudia Delgado-Corcoran, Katherine H Wolpert, Kathryn Lucas, Stephanie Bodily, Angela P Presson, Susan L Bratton
OBJECTIVE: To determine whether judicious blood testing impacts timing or amount of packed RBC transfusions in infants after heart surgery. DESIGN: A retrospective study comparing before and after initiation of a quality improvement process. SETTING: A university-affiliated cardiac ICU at a tertiary care children's hospital. PATIENTS: Infants less than 1 year old with Risk Adjustment for Congenital Heart Surgery category 4, 5, 6, or d-transposition of great arteries (Risk Adjustment for Congenital Heart Surgery 3) consecutively treated during 2010 through 2013...
November 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27640906/short-term-postoperative-breast-cancer-outcomes-in-patients-with-advanced-age
#20
Erica Pettke, Nicole Ilonzo, Martha Ayewah, Sara Tsantes, Alison Estabrook, Aye Moe Thu Ma
BACKGROUND: This study compares early postoperative breast cancer outcomes between patients 80 years and older (older patients) and those younger than 80 years (<80 years). METHODS: The National Surgical Quality Improvement Program database was used to identify patients who had breast surgery between 2005 and 2013 for malignancy. RESULTS: Older patients had a significantly higher percentage of comorbidities and partial mastectomies. Postoperatively, they had higher rates of pneumonia, urinary tract infection, cardiac arrest, and mortality but had lower rates of wound dehiscence, deep wound, and organ space infections...
October 2016: American Journal of Surgery
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